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Full text of "The Medicare directory of prevailing charges"

¥ 




Medicare 

Directory of 

Prevailing Charges 



Health Care Financing Administration 

BHIPub. No. 035(5-77) 



I 



c 



• 



MEDICARE DIRECTORY OF PREVAILING CHARGES FOR FEE SCREEN YEAR 1977 

Introduction 

This directory contains Medicare reimbursement data for Fee Screen Year 1977. It lists the prevailing charge 
for 50 high volume physician medical procedures for each of the reasonable charge localities within each 
carrier's service area. Maps are provided for each State which outline the separate charge districts (local- 
ities) the carriers use in reimbursing claims under the Medicare program.* In addition, the counties 
within each locality are listed to aid in identifying the exact geographic breakdowns. (More detailed 
locality information can be obtained on selected carriers by referring to Appendix A in the back of the 
di rectory.) 

This prevailing charge data represents the maximum amounts upon which reimbursement is based within the 
Medicare Part B program. It also reflects the influence of the Economic Index Rollback Provisions. For 
each locality, prevailing charges are listed for General Practitioners and for medical Specialists except 
where the carrier makes no specialty differentiation in li'ts screens, in which case the top of the page 
states, "combined screens." Blank spaces in the prevailing charge colums indicate that the procedure is 
not performed in the locality or that the carrier does not use the same definition of the procedure as 
listed. When an asterisk (*) appears beside a charge, it means that the charge is computed using a relative 
value scale rather than being based on actual charge data for the period covered. 

When consulting the specialist sheets, it should be noted that the amounts represent the prevailing charge 
for the specialist who most frequently performs these procedures. Therefore, the procedure list in Table A 
contains the category of medical specialists and the appropriate specialty code next to each item for the 
50 procedures. 

If you have any questions about the data or. locality information displayed in this directory, please direct 
your requests to Mr. James Barnett, Health Care Financing Administration, Bureau of Health Insurance, 
Division of Contractor Operations, Carrier Performance Section, Raom 2 1 CdsL Du+-UU-oa (low rise). 4404^' 
Security Blvd., Baltimore, Maryland 21235. 



*For a more detailed discussion of the Medicare program reasonable charge methodology, the reader is 
directed to BH1 Publication No. 028 entitled, Determination of Reasonable Charges under Part B of Medicare 



Additional copies of the directory can be requested f 



rom: 



Bureau of Health Insurance 

Mr. Richard Rhode 

Administrative Services Section Chief 

Room G-J-3 East Building (low rise) 

6A01 Security Blvd. 

Baltimore, Marylabd 21235 















11 



Table A 



Frequently Performed Medical Procedures 



• 



Procedure and 64 CRVS Code 

1. Initial Limited Office Visit (9000) New Patient 

2. Initial Comprehensive Office Visits (9002) New Patient 

3. Minimal Office Vis i f-Establ ished Patient (9003) 

4. Routine Followup Brief Office Visits (900*0 Established Patient 

5. Routine Followup Brief Home Visit (9014) 

6. Initial Brief Hospital Visit (9020) 

7. Initial Comprehensive Hospital Visit (9022) 

8. Routine Followup Brief Hospital Visits (9024) 

9. Biopsy Skin (0171) 

10. Radical Mastectomy (0470 

11. Reduction of Fracture — Neck of Femur (0868) 

12. Arthorotmy — Puncture for Aspiration of joint effusion (1046) 

13. Needle puncture of bursa (1413) 

14. Bronchoscopy (2111) 

15. Thoracentesis (2183) 

16. Catheterization of Heart (2330) 

17. Insertion of pacemaker (2356) 

18. Blood Transfusion (2445) 

19. Colectomy (3179) 

20. Appendectomy (3261) 

21. Sigmoidoscopy (33 1 0) 

22. Hemorrhoidectomy (3380) 

23. Cholecystectomy (3515) 

24. Repair Hernia (363 1) 

25. Cystoscopy (3930) 

26. Dilation of Urethra (4031) 

27. Prostatectomy (431 6) 

28. Transurethral Electrosect ion of Prostate (4341 ) 

29. Hysterectomy (4632) 

30. Extraction of Lens (56II) 



Specialist and Specialty Code 

Internal Medicine (1 
Internal Medicine (1 
Internal Medicine (1 
Internal Medicine (1 
Internal Medicine (1 
Internal Medicine (1 
Internal Medicine (1 
Internal Medicine (1 
General Surgery (02) 
General Surgery (02) 
Orthopedic Surgery (20) 
Orthopedic Surgery (20) 
General Surgery (02) 
General Surgery (02) 
General Surgery (02) 
Cardiovascular (06) 
Cardiovascular (06) 
General Surgery (02) 
General Surgery (02) 
General Surgery (02) 
General Surgery (02) 
General Surgery (02) 
General Surgery (02) 
General Surgery (02) 
Urology (34) 
Urology (34) 
Urology (34) 
Urology (34) 

Obstetrics — Gynecology (16) 
Opthalmology (18) 



111 



Procedure and 6k CRVS Code 



3). Chest X-ray (7100) 

32. X-ray Spine (7210) 

33- X-ray Hip (7300) 

34. X-ray Stomach (7356) 

35. X-ray Colon (7360) 

36. Cobalt (7603) 

37. Radiotherapy — Supervol tages (7609) 

38. Hemoglobin (8622) 

39. BJood, white cell count (8624) 

40. Complete Blood Count (8628) 

41. Cholesterol Blood Test (8652) 
hi. Hematocrit (8681) 

43. Prothrombin Time Test (8712) 

kk. Sedimentation Rate (8718) 

kS. Blood Sugar (8722) 

46. BUN— Urea Nitrogen (87^5) 

47. Pap Test (8911) 

48. Urinalysis (8986) 

49. EKG (Electrocardiogram) (9101) 

50. EEG (Electroencephalogram) (933D) 



Specialist and Specialty Code 



Radiology (30) 

Radiology (30) 

Radiology (30) 

Radiology (30) 

Radiology (30) 

Radiology (30) 

Radiology (30) 



I nternal 
Internal 
Internal 
Internal 
Internal 
Internal 
Internal 
Internal 
Internal 
Internal 
Internal 
Internal 



Med 
Med 
Med 
Med 
Med 
Med 
Med 
Med 
Med 
Med 
Med 
Med 



Neurology (13) 



ne ( 
ne ( 
ne ( 
ne ( 
ne ( 
ne ( 
ne ( 
ne ( 
ne ( 
ne ( 
ne ( 
ne ( 



IV 



ALABAMA 



ALABAMA 




Six Localities: 

01 - Seven N.W. Counties 

02 - Six North Central Counties 

03 - Eight S.E. Counties 

04 - Two S.W. Counties 

05 - One large Metropolitan County 

06 - Forty-one small Rural Counties 

(For more locality information see 
Appendix A) 



197 RE 



lEVAILlNG CHARGE SUMMARY DATA B/C-B/S OF ALABAMA 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 
PROCEDURE DESCRIPTION 01 02 03 04 05 



ALABAMA 

LOCALITY DESIGNATION FOR SPECIALIST 
01 02 03 04 



05 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

1 1 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



INITIAL LIMITED OFFICE VISIT 

INITIAL COMP OFFICE VISIT 

MINIMAL OFFICE VISIT 

ROUTINE BRIEF OFFICE VISIT 

ROUTINE BRIEF HOME VISIT 

INITIAL BRIEF HOSPITAL VISIT 

INITIAL COMP HOSPITAL VISIT 

ROUTINE BRIEF HOSPITAL VISIT 

BIOPSY SKIN 

RADICAL MASTECTOMY 

REDUCTION OF FRACTURE 

ARTHOTMY 

NEEDLE PUNCTURE OF BURSA 

BRONCHOSCOPY 

THORACENTESIS 

CATHPTFpfATION 

INSERTION OF PACEMAKER 

BLOOD TRANFUSION 

COLECTOMY 

APPENDECTOMY 

SIGMOIDOSCOPY 

HEMORRHOIDECTOMY 

CHOLECYSTECTOMY 

REPAIR HERNIA 

CYSTOSCOPY 

DILATION OF URETHRA 

PROSTATECTOMY 

ELECTROSECTION OF PROSTATE 

HYSTERECTOMY 

EXTRACTION OF LENS 

X-RAY CHEST 

X-RAY SPINE 

X-RAY HIP 

X-RAY STOMACH 

X-RAY COLON 

COBALT 

RADIOTHERAPY 

HEMOGLOBIN 

WHITE CELL COUNT 

COMPLETE BLOOD COUNT 

CHOLESTERAL BLOOD COUNT 

HEMATOCRIT 

PROTHROMBIN 

SEDIMENTATION RATE 

BLOOD SUGAR 

BUN UREA NITRATE 

PAP TEST 

URINALYSIS 

ELECTROCARDIOGRAM 

ELECTROENCEPHALOGRAM 



28.10 

12.00 
15.00 

40.00 
5.50 

15.00 
500.00 
638.20 

22.00 

15.75 
127.60 

25.00 
250.00 

25.50 

600.00 

275.00 

25.00 

200.00 

400.00 

300.00 

35.00 

20.00 

600.00 

560.00 

450.00 

574.40 

15.00 

30.00 

19.20 

44.70 

35.00 

12.80 

13.20 

3.00 

5.00 

10.00 

8.00 

5.00 

6.00 

5.00 

10.00 

8.00 

12.00 

7.00 

15.10 

60.00 



30.00 

13.00 
15.00 

40.00 
5.00 

15.00 
500.00 
638.20 

20.00 

25.00 
127.60 

50.00 
250.00 

25.50 

600.00 

250.00 

25.00 

287.20 

400.00 

300.00 

35.00 

20.00 

600 . 00 

560.00 

450.00 

574.40 

15.00 

25.00 

20.00 

40.00 

35.00 

12.80 

19.20 

3.00 

5.00 

8.00 



00 
00 



8.00 

5.00 

8.00 

6.00 

10.00 

7.00 

20.00 

60.00 



30.00 

14.00 
15.00 

40.00 
12.50 
15.00 

500.00 

638.20 
20.00 
25 . 00 

127.60 
25.00 

250.00 

25.50 

600.00 

250.00 

25.00 

250.00 

400.00 

300-00 

35.00 

24.00 

600.00 

560.00 

450.00 

574.40 

15.30 

25.50 

19.30 

40.00 

35.00 

12.80 

19.20 

1 .60 

6.00 

8.00 

8.00 

5.00 

6.60 

6 . 00 

9.00 

8.00 

10.00 

7.00 

20.00 

60.00 



30.00 

12.00 
15.00 

40.00 
7.50 

15.00 
550 . 00 
638.20 

20.00 

15.00 
127.60 

25 . 00 
250.00 

25.50 

600 . 00 

250.00 

25 . 00 

287.20 

1 00 . 00 

300.00 

35.00 

10.00 

600.00 

560.00 

450.00 

574.40 

19.20 

25.50 

20.00 

40.00 

35.00 

12.80 

19.20 

2.80 



00 
70 



8.00 
5.00 
6.00 
5.00 

10.00 
5.00 

10.00 
7.00 

20.00 

60.00 



35.00 

15.00 
20.00 

40.00 

12.50 

15.00 

500.00 

638.20 

25.00 

30.00 

127.60 

100.00 

250.00 

25.50 

600.00 

250.00 

25.00 

287.20 

400 . 00 

300.00 

35.00 

30.00 

600.00 

560.00 

450.00 

574.00 

20.00 

20.00 

20.00 

40.00 

35.00 

12.80 

19.20 

6.50 

5.00 

10.00 

8.00 

5.00 

8.00 

6.00 

1 . 00 

8.00 

15.00 

7.00 

20.00 

60.00 



31.90 

12.00 
15.00 

40.00 
7.00 

40.00 
550.00 
638.20 

22.00 

15.00 
127.60 

40.00 
2 1 . 00 

25.50 

650.00 

250.00 

35.00 

250.00 

446.70 

300.00 

63.80 

20i00 

600.00 

510.60 

574.40 

540.00 

15.00 

30.00 

19.20 

45.00 

40.00 

13.00 

15.00 

4.00 

5.00 

8.00 

8.00 

5.00 

6.00 | 

5.00*' 

10.00 

8.00 

10.00 

7.00 

16.00 

55.00 



38.30 

13.00 
19.20 

40.00 
12.50 
35.00 

540.00 

638.20 
20.00 
25.00 

175.00 
50.00 

210.00 

25.50 

600.00 

285.00 

25.00 

250.00 

435.00 

300.00 

50.00 

20.00 

574.40 

542.50 

500.00 

500.00 

15-00 

25.00 

20.00 

48.00 

42.00 

25.00 

24.00 

3.80 

5.00 

8.00 

6.00 

5.00 

8.00 

8.00 

8.00 

6.00 

10.00 

7.00 

20.00 

55.00 



40.00 

1 4 . 00 
20.00 

44.70 

12.50 
22.30 

520.00 

638.20 
20.00 
15.00 

120.00 
50.00 

2 1 . 00 

25.50 
600.00 
250.00 

31.90 
210.00 
446.70 
300.00 

65.00 

24.00 
560.00 
560.00 



500 
525 



00 
00 



17.00 

35.00 

19.20 

50.00 

50.00 

25.00 

30.00 

4.00 

6.00 

8.00 

7.00 

5.00 

6.00 

6.00 

9 . 00 

8.00 

10.00 

7.00 

20.00 

55.00 



40 . 00 

12.00 
15.00 

40.00 
15.00 
22.30 

550.00 

638.20 
20.00 
15.00 

140.00 
75.00 

210.00 

25.50 

700.00 

300.00 

31 .90 

300 . 00 

460.00 

300.00 

60.00 

45.00 

600.00 

550.00 

550.00 

574.40 

16.60 

25.50 

19.20 

45.00 

44.70 

15.00 

19.20 

3.00 

5.00 

7.00 

8.00 

5.00 

6.00 

5.00 

10.00 

5.00 

10.00 

7.00 

20.00 

55.00 



50.00 

15.00 
25.00 

45.00 

14.40 

50.00 

638.20 

600.00 

25.00 

30.00 

140.00 

100.00 

300.00 

25.50 

1000.00 

272.60 

31 .90 

300.00 

510.60 

319.10 

55.00 

30.00 

600.00 

550.00 

574.40 

638.20 

20.00 

25.50 

20.00 

44.70 

40.00 

37.00 

23.00 

2.00 

5.00 

10.00 

8.00 

5.00 

8.00 

6.00 

10.00 

7.00 

10.00 

7.00 

21 .00 

55.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



1977 PREVAILING CHARGE SUMMARY DATA B/C-B/S OF ALABAMA 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



06 



25 . 00 

1 2 . 00 
15-00 

40.00 
10.00 
15.00 

500.00 

638.20 
15.00 
25.00 

127.60 
75-00 

250.00 

25.50 

600.00 

250.00 

25-00 

287.20 

375.00 

250.00 

35.00 

15.00 

600.00 

560.00 

450.00 

574.00 

1 6 . 00 

25.00 

18.00 

40.00 

38.30 

12.80 

19-20 



00 
00 



8.50 
8.00 



00 
00 
40 



8.00 

7.00 

10.00 

7.00 

19.20 

60.00 



ALABAMA 
LOCALITY DESIGNATION FOR SPECIALIST 

06 

.44.70 



12.00 
15.00 

45.00 
15.00 
35.00 

550.00 

638.20 
19.20 
10.00 

125.00 
75.00 

250.00 

25.50 
702.00 
297.00 

31.90 
225.00 
414-80 
250.00 

51 .10 

10.00 
600.00 
560.00 
574.40 
550.00 

16.00 

25. 






■s . -.. ■ ' .'i v 



,50 
19.20 
51.10 
44.70 
15.00 
19.20 
2.70 



00 
00 
00 
00 
00 
00 



; . 



8.00 

7.70 

10.00 

5.00 

25.00 

55.00 



.■"-■ 



■ . 



■:■:■<■■.■>;•:•:■:■:■.-■' 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

1 7 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



ALASKA 









ALASKA 




-^ 



j. .«;*&' 



AUlJtWfc ilcWrtK iMM 



One Locality - Statewide 



1977 PREVAILING CHARGE SUMMARY DATA AETNA LIFE AND CASUALTY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 
IS CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 CC3ALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



SINGLE 


63. 


80 


10. 


20 


15. 


00 


25. 


00 


38. 


30 


63. 


80 


15. 


00 


15. 


00 


738 


00 


968 


00* 


30 


00 


27. 


00 


192 


00 


35 


60 


419 


60 


1210 


00* 


24 


20* 


1020 


80 


523 


00 


35 


00 


385 


00 


725 


00 


423 


00 


80 


00 


22 


00 


918 


70 


1020 


80 


847 


00* 


900 


.00 


23 


00 


40 


■ 00 


39 


00 


71 


.50 


61 


.30 


33 


• 00* 


44 


■ 00* 


4 


■ 50 


5 


.00 


12 


.00 


13 


• 50 


4 


■ 50 


10 


.00 


8 


.00 


12 


.00 


12 


• 50 


13 


.00 


7 


.00 


36 


.00 


76 


• 60 



ALASKA 
LOCALITY DESIGNATION FOR SPECIALIST 
SINGLE 



:. ■■: 



63.80 
10.80 
15.30 
22 . 00 
38.30 
70.00 
15.30 
30.00 

669.90 
1080.00* 
31 .90 
30.00 

192.00 
40.00 

444. 10 
1220.00* 
25.80* 
1020.80 

474.70 
36.00 

385.00 

740. 10 

450.00 
80.00 
18.00 

918.70 

918.70 
1113. 00* 

900.00 
23.00 
40.00 
38.30 
71.50 
61.30 
32.40* 
43.20* 
5. 
4. 



.00 
,00 



15.00 
13.80 

4.40 
1 . 00 

7.00 
1 1 . 50 
13.80 

9.00 

6.00 
32.50 
76.60 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



AMERICAN SAMOA 



"W SfLAtLA 



(7 



r^ 



*»A1N* BL AW 




Ml ISLAND 



MAMU'A DISTRICT 
MANUA ISLANDS 







'.— SANO IHAMO 

— "^ most isiamo 



> 



\ LtAS'N* CO. ^J 



V 



»co. 



tuS. 



o 8 



rOLA ISLANO 

A NuusrrooA island 

-^ ) IBAWTLCTT ISLAND' 

ii \l.i .«.•-..-,> iiyC^PIli." SAOLCCO -mu# 

UAO CO 7.*S>^'' '"'" '' ,4C " W4 ""* > " ' PT ' «UNU'U ISLA 

' "5^ 



' /""^H« J TUALAUTA 

/•-••<? r\ CO 



TLTt.'ILA ISLAND 



No Locality- No fee-f or—service physicians. All Part B claims 
(i.e., outpatient hospital services) are processed by 
Aetna-Hawaii. 



8 



ARIZONA 



ARIZONA 




Six Localities: 

01 - Phoenix 

02 - Tucson 
0£ - Flagstaff 

07 - Prescott 

08 - Tuma 
99 - All other parts of the State 

(Fpr more locality information 
see Appendix A) ^A 



10 



1977 PREVAILING CHARGE SUMMARY DATA AETNA LIFE AND CASUALTY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 



01 



02 



07 



08 



05 



ARIZONA 
LOCALITY DESIGNATION FOR SPECIALIST 
01 02 07 08 



05 






01 


INITIAL LIMITED OFFICE 


VISIT 








:::: : :> : :'.": : .-.v. : - , .:.-->*; 1 |; : :;:;' 


:; : :'"i^>v': < 




."■' 






1 


: .- 




01 


02 


INITIAL COMP OFFICE 


VISIT 


44.70 


38 


30 


44.70 


44 


70 


44.70 


57.40 


63.80 


57.40 


57.40 


57.40 


02 


03 


MINIMAL OFFICE VISIT 




6.40 


8 


00 


6.40 


2 


60 


6.40 


6.00 


6.40 


6.40 


6.40 


6.40 


03 


04 


ROUTINE BRIEF OFFICE VISIT 


10.20 


10 


00 


10.20 


9 


60 


8.90 


15.00 


12.80 


12.80 


12.80 


10.30 


04 


05 


ROUTINE BRIEF HOME VISIT 


19.10 


19 


10 


15.00 


19 


10 


16.00 


25.00 


: 19. 10 


20.00 


20.00 


20.00 


05 


06 


INITIAL BRIEF HOSPITAL 


VISIT 


31 .90 


35 


00 


30.00 


44 


70 


40.00 


44.70 


38.00 


44.70 


44.70 


45.00 


06 


07 


INITIAL COMP HOSPITAL 


VISIT 


48.00 


45 


90 


50.00 


50 


00 


50.00 


60.00 


44.70 


51 .00 


51 .00 


51 .00 


07 


08 


ROUTINE BRIEF HOSPITAL 


VISIT 


12.80 


12 


00 


10.20 


10 


00 


12.80 


15.00 


12.80 


15.00 


15.00 


15.00 


08 


09 


BIOPSY SKIN 




25.00 


25 


00 


25.00 


25 


00 


25.00 


30.00 


38.30 


30.00 


30.00 


30.00 


09 


10 


RADICAL MASTECTOMY 




689.00 


689 


00 


689.00 


689 


00 


689.00 


700.00 


638.00 


700.00 


700.00 


700.00 


10 


1 1 


REDUCTION OF FRACTURE 




728.00* 


640 


00* 


600.00* 


640 


00* 


712.00* 


864.00* 


736.00* 


816.00* 


816.00* 


816.00 


1T 


12 


ARTHOTMY 




19.10 


20 


00 


15-00 


19 


10 


19.10 


19.10 


19.10 


19. 10 


19.10 


19. 10 


12 


13 


NEEDLE PUNCTURE OF BURSA 


20.00 


20 


00 


20.00 


20 


00 


20.00 


20.00 


20.00 


20.00 


20.00 


20.00 


13 


14 


BRONCHOSCOPY 




159.50 


159 


50 


159.50 


159 


50 


159.50 


159.50 


159.50 


159.50 


159.50 


159.50 


14 


15 


THORACENTESIS 




31.90 


31 


90 


31-90 


31 


90 


31-90 


31.90 


31 .90 


31 .90 


31.90 


38.30 


15 


16 


CATHF.TERT7ATI0N 




370.00 


370 


00 


370-00 


370 


00 


370.00 


370.00 


303.70 


370.00 


370.00 


370.00 


16 


17 


INSERTION OF PACEMAKER 




950.00 


950 


00 


950.00 


950 


00 


950.00 


950.00 


950.00 


950.00 


950.00 


950.00 


17 


18 


BLOOD TRANFUSION 




18.20* 


16 


00* 


15.00* 


16 


00* 


17.80* 


19.20* 


18.40* 


18.80* 


18.80* 


20.40 


18 


19 


COLECTOMY 




756.00 


756 


00 


756-00 


756 


00 


756.00 


756.00 


700.00 


756.00 


756.00 


756.00 


19 


20 
21 


APPENDECTOMY 




382.80 


382 


80 


382-80 


382 


80 


382.80 


380.00 


382.80 


382.80 


382.80 


382.80 


20 


SIGMOIDOSCOPY 




26.80 


31 


90 


26.80 


26 


80 


26.80 


30.00 


25.00 


25.50 


25.50 


25.50 


21 


22 


HEMORRHOIDECTOMY 




319.00 


319 


00 


3 1 9 - 00 


319 


00 


3 1 9 . 00 


300.00 


290.90 


300.00 


300.90 


300.00 


22 


23 


CHOLECYSTECTOMY 




510.40 


510 


40 


510.40 


510 


40 


510.40 


606.10 


535.90 


574.20 


574.20 


574.20 


23 


24 


REPAIR HERNIA 




319.00 


315 


00 


315.00 


315 


00 


315.00 


357.30 


331 .80 


357.30 


357.30 


357.30 


24 


25 


CYSTOSCOPY 




44.70 


44 


70 


44.70 


44 


70 


44 . 70 


44.70 


45.00 


44.70 


44.70 


44.70 


25 


26 


DILATION OF URETHRA 




19.10 


21 


10 


21 . 10 


21 


10 


21 .10 


18.00 


15.00 


18.00 


18.00 


18.00 


26 


27 


PROSTATECTOMY 




676.30 


676 


30 


676.30 


676 


30 


676.30 


714.60 


663.50 


676.30 


676.30 


676.30 


27 


28 


ELECTROSECTION OF PROSTATE 


701 .80 


701 


80 


701 .80 


701 


80 


701 .80 


714.60 


663.50 


701 .80 


701 .80 


701 .80 


28 


29 


HYSTERECTOMY 




638.00 


638 


00 


638.00 


638 


00 


638.00 


638.00 


638.00 


638.00 


638.00 


638.00 


29 


30 


EXTRACTION OF LENS 




638.00 


638 


00 


638.00 


638 


00 


638.00 


638.00 


638.00 


638.00 


638.00 


638.00 


30 


31 


X-RAY CHEST 




19. 10 


16 


00 


19-00 


15 


00 


19.00 


21.10 


15.30 


1 6 . 00 


16.00 


16.00 


31 


32 


X-RAY SPINE 




31 .90 


35 


00 


31 .90 


31 


90 


31 -90 


39.00 


23.00 


35.70 


35.80 


35.70 


32 


33 


X-RAY HIP 




30.00 


30 


00 


30.00 


30 


00 


30.00 


28.10 


25.00 


25.00 


25.00 


25.00 


33 


34 


X-RAY STOMACH 




45.00 


45 


00 


45.00 


45 


00 


45.00 


48.00 


53.60 


53.60 


53.60 


53-60 


34 


35 


X-RAY COLON 




40.00 


40 


00 


40 . 00 


40 


00 


40.00 


48.00 


45.90 


49.00 


49.00 


49.00 


35 


36 


COBALT 




19.10 


19 


10 


19-10 


19 


10 


19.10 


19.10 


19.10 


19. 10 


19.10 


19. 10 


36 


37 


RADIOTHERAPY 




19.10 


19 


10 


19.10 


19 


10 


19.10 


19.10 


19. 10 


19. 10 


19.10 


19. 10 


37 


38 


HEMOGLOBIN 




3.00 


5 


00 


4.00 


4 


00 


4.00 


4.00 


2.25 


4.00 


4.00 


4.00 


38 


39 


WHITE CELL COUNT 




4.00 


4 


00 


4.00 


4 


00 


4.00 


4.00 


2.50 


4.00 


4.00 


4.00 


39 


40 


COMPLETE BLOOD COUNT 




8.00 


8 


00 


8.00 


7 


00 


8.00 


8.00 


8.00 


8.00 


8.00 


8.00 


40 


41 


CHOLESTERAL BLOOD COUNT 


6.50 


7 


50 


6.50 


6 


50 


6.50 


7.00 


6.00 


7.00 


7.00 


7.00 


41 


42 


HEMATOCRIT 




4.00 


2 


00 


2.00 


4 


00 


4.00 


4.00 


2.25 


4.00 


4.00 


4.00 


42 


43 


PROTHROMBIN 




6.00 


5 


50 


5.00 


6 


00 


6.00 


6.00 


5.50 


5.50 


5.50 


5.50 


43 


44 


SEDIMENTATION RATE 




5.00 


4 


00 


5.00 


5 


00 


5.00 


4.00 


4.00 


4.00 


4.00 


4.00 


44 


45 


BLOOD SUGAR 


D ■ D*J 


6 


00 


6.50 


7 


00 


6.50 


6.00 


5.00 


6.00 


6.00 


6.00 


45 


46 


BUN UREA NITRATE 




6.50 


7 


00 


6.50 


6 


50 


6.50 


7.50 


6.00 


7.00 


7.00 


7.00 


46 


47 


PAP TEST 




8.00 


10 


00 


8.00 


15 


00 


8.00 


7.50 


5.00 


7.00 


7.00 


7.00 


47 


48 


URINALYSIS 




5.00 


5 


00 


4.00 


4 


00 


4.00 


5.00 


4.00 


5.00 


5.00 


5.00 


48 


49 


ELECTROCARDIOGRAM 




22.00 


20 


00 


23.00 


21 


00 


23.00 


22.00 


19.10 


20.00 


20.00 


20.00 


49 


50 


ELECTROENCEPHALOGRAM 




60.00 


60 


00 


60.00 


60 


00 


60.00 


60.00 


60.00 


60.00 


60.00 


60.00 


50 



11 



1977 PREVAILING CHARGE SUMMARY DATA AETNA LIFE AND CASUALTY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 
PROCEDURE DESCRIPTION 99 



ARIZONA 
LOCALITY DESIGNATION FOR SPECIALIST 

99 





01 




02 




03 




04 




05 




06 




07 




08 




09 




10 




1 1 




12 




13 




14 




15 




16 




17 




18 




19 




20 




21 




22 




23 




24 




25 




26 




27 




28 




29 




30 




31 




32 




33 




34 




35 




36 




37 




38 




39 




40 




41 




42 




43 




44 




45 




46 




47 




48 




49 




50 



INITIAL LIMITED OFFICE VISIT 

INITIAL COMP OFFICE VISIT 

MINIMAL OFFICE VISIT 

ROUTINE BRIEF OFFICE VISIT 

ROUTINE BRIEF HOME VISIT 

INITIAL BRIEF HOSPITAL VISIT 

INITIAL COMP HOSPITAL VISIT 

ROUTINE BRIEF HOSPITAL VISIT 

BIOPSY SKIN 

RADICAL MASTECTOMY 

REDUCTION OF FRACTURE 

ARTHOTMY 

NEEDLE PUNCTURE OF BURSA 

BRONCHOSCOPY 

THORACENTESIS 

CATHETERIZATION 

INSERTION Or PACEMAKER 

BLOOD TRANFUSION 

COLECTOMY 

APPENDECTOMY 

SIGMOIDOSCOPY 

HEMORRHOIDECTOMY 

CHOLECYSTECTOMY 

REPAIR HERNIA 

CYSTOSCOPY 

DILATION OF URETHRA 

PROSTATECTOMY 

ELECTROSECTION OF PROSTATE 

HYSTERECTOMY 

EXTRACTION OF LENS 

X-RAY CHEST 

X-RAY SPINE 

X-RAY HIP 

X-RAY STOMACH 

X-RAY COLON 

COBALT 

RADIOTHERAPY 

HEMOGLOBIN 

WHITE CELL COUNT 

COMPLETE BLOOD COUNT 

CHOLESTERAL BLOOD COUNT 

HEMATOCRIT 

PROTHROMBIN 

SEDIMENTATION RATE 

BLOOD SUGAR 

BUN UREA NITRATE 

PAP TEST 

URINALYSIS 

ELECTROCARDIOGRAM 

ELECTROENCEPHALOGRAM 






35.00 

6.00 

8.90 

19.10 

31 .90 

35.00 

10.20 

25.00 

689.00 

576.00' 

19.10 

20.00 

159.50 

31 .90 

370.00 

950.00 

14.40" 

756.00 

382.80 

35.00 

3 1 9 . 00 

510.40 

300.00 

44.70 

19. 10 

676.30 

701 .80 

638.00 

638.00 

16.00 

27.00 

30.00 

51 

44. 

19. 

19. 

4. 

3. 

9. 

7. 

3. 

7. 

6. 

.:■ ■ 7. 



.00 

.70 

10 

. 10 

.00 

.00 

.00 

• 50 

50 

.00 

.00 

.00 

8.00 

10.00 

5.00 

25.00 

60.00 



- 57.40 

6.40 

8.90 

20.00 

38.30 

51 .00 

10.50 

30.00 

700.00 

816.00* 

19. 10 

19.00 

159.50 

31 .90 

370.00 

950.00 

18.80* 

756.00 

382.80 

25.50 

300.00 

510.40 

3 1 1 . 50 

44.70 

18.00 

676.30 

701 .80 

638.00 

638.00 

16.00 

35.70 

25.00 

53.60 

49.00 

19. 10 

19.10 

4.00 

4.00 

9.00 

7.00 

4.00 

5.50 

4.00 

6.00 

7.00 

6.50 

4.50 

19.10 

60.00 



01 
02 
03 
04 
05 
06 
07 



11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 



31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 






12 
























ARKANSAS 









13 













Five Localities: 

01 - Pulaski, Sebastian 

02 - Craighead, Garland, Jefferson, Miller, Union, Washington 

03 — Crittenden, Mississippi, Ouachita, Phillips, Pope, Saline 

04 - Arkansas, Ashley, Baxter, Benton, Boone, Chicot, Clark, 

Columbia, Faulkner, Greene, Hot Spring, Independence, 
Jackson, St. Francis, White 

05 - Bradley, Calhoun, Carroll, Clay, Cleburne, Cleveland, 

Conway, Crawford, Cross, Dallas, Desha, Drew, Franklin, 

Fulton, Grant, Hempstead, Howard, Izard, Johnson, 

Lafayette, Lawrence, Lee, Lincoln, Logan, Little Kiver, 

Lonoke, Madison, Marion, Monroe, Montgomery, Nevada, Newton, 

Perry, Pike, Poinsett, Polk, Prairie, Randolph, Scott, 

Sevier, Searcy, Sharp, Stone, Van Buren, Woodruff, Yell (Counties) 



1977 PREVAILING CHARGE SUMMARY DATA ARKANSAS B/C-B/S 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD T RAN FUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 CC3ALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



001 



002 



003 



004 



005 



ARKANSAS 
LOCALITY DESIGNATION FOR SPECIALIST 

001 002 003 004 005 



31.90 


15.00 


20.00 


25 . 00 


15.00 


90.00 


31.90 


31 .90 


38.30 


65.00 


01 
02 
03 
04 


8.90 


7.70 


7.70 


6 . 40 


6.40 


10.20 


9.60 


8 . 90 


7.70 


10.00 


15.00 


1 2 . 00 


12.80 


12.80 


10-00 


19.10 


11 .00 


: 15.00 


10.00 


17.50 


05 


30.00 


25.00 


25.00 


25.00 


25.00 


50.00 


35.00 


25.00 


25.00 


40.00 


06 


35.00 


35.00 


25.00 


31 -90 


27.00 


75.00 


38.30 


25.00 


35.00 


44.70 


07 


12.80 


8.90 


7.00 


7.70 


7.70 


12.80 


12.00 


5.00 


7.00 


10.00 


08 


20.00 


20.00 


18.00 


20.00 


20.00 


25.00 


25.00 


19.50 


19.10 


19. 10 


09 


550.00 


638.00 


510.40 


425.00 


550.00 


550.00 


638.00 


510.40 


425.00 


550.00 


10 


616.00* 


512.00* 


512.00* 


512.00* 


512.00* 


616.00* 


512-00* 


616.00* 


512.00* 


512. 00* 


Wii 


15.00 


15.00 


15.00 


15.00 


15.00 


15.00 


15.00 


15.00 


15.00 


15.00 


12 


15.40* 


12.80* 


12.80* 


12.80* 


12.80* 


15.40* 


12.80* 


15.40* 


12.80* 


12.80* 


13 


127.60 


159.50 


95.70 


95.70 


127.60 


127.60 


159.50 


95.70 


95.70 


127.60 


14 


15.00 


15.00 


15.00 


15.00 


15.00 


31.90 


35.00 


34.00 


35.00 


3 1 . 90 


.- 1 5 


255.20 


255.20 


255.20 


255.20 


255.20 


255.20 


255.20 


255.20 


255.20 


400.00 


16 


400.00 


400.00 


400.00 


400 . 00 


400.00 


400.00 


400.00 


400.00 


400.00 


255.20 


17 


15.40* 


12.80* 


12.80* 


12.80* 


12. 80* 


15.40* 


12.80* 


15.40* 


12.80* 


12.80* 


18 


650.00 


500.00 


600.00 


600.00 


600.00 


650.00 


500.00 


600.00 


574.20 


600.00 


19 


250.00 


250.00 


250.00 


250.00 


250.00 


300.00 


300.00 


255.20 


250.00 


300.00 


20 


19.10 


30.00 


25.00 


20.00 


25.00 


35.00 


25.00 


31.90 


31.90 


35.00 


21 


308.00* 


256.00* 


256.00* 


256.00* 


256.00* 


308.00* 


256.00* 


308.00* 


256.00* 


256.00* 


22 


385.00 


400.00 


382.80 


385.00 


382.80 


446.60 


435.00 


382.80 


375.00 


446.60 


23 


250.00 


250.00 


210.00 


250 . 00 


223.30 


3 1 . 00 


268.00 


255.20 


250.00 


255.20 


24 


63.80 


44.70 


44.70 


31 .90 


63 . 80 


63.80 


50.00 


44.70 


50.00 


63.80 


25 


10.00 


15.00 


10.00 


10.00 


10.00 


11 .00 


10.00 


12.00 


10.00 


1 1 .00 


26 


542.30 


510.40 


480.00 


510.40 


510.40 


542.30 


510.40 


382.80 


510.40 


510.40 


27 


546.10 


510.40 


480.00 


542 . 30 


542.30 


546. 10 


510.40 


382.80 


542.30 


542.30 


28 


600.00 


600.00 


600.00 


600 . 00 


600.00 


600.00 


600.00 


600.00 


600.00 


600.00 


29 


450.00 


475.00 


480.00 


450.00 


450.00 


450.00 


446.60 


446.60 


450.00 


446.60 


30 


17.00 


15.00 


1 5 . 00 


15.00 


15.00 


15.00 










31 


35.00 


35.00 


35.00 


35.00 


25.00 


35.00 










32 


15.00 


18.00 


18.50 


17.00 


18.00 


15.00 










33 


23.10* 


19.20* 


19.20* 


19.20* 


19.20* 


22.20* 










34 


35.00 


31 .90 


38.30 


40 . 00 


40.00 


38 . 30 










35 


25.00 


21 .70 


21 .70 


21 .70 


21 .70 


25.00 










36 


20.00 


20.00 


20.00 


20.00 


20.00 


20.00 










37 


3.50 


3.00 


2.00 


3.00 


3.00 


3.00 


3.00 


3.00 


3.00 


3.00 


38 


3.00 


4.00 


4.00 


3.00 


3.00 


3.50 


3.00 


3.00 


3.00 


3.00 


39 


9.75 


8.00 


7.00 


8.00 


8.00 


12.25 


8.00 


7.00 


8.50 


8.50 


40 


8.00 : 


5.50 


7.00 


7.00 


6.00 


8.25 


! 6.00 


8.00 


6.00 


8.00 


41 


4.00 


3.00 


4.00 


3 . 00 


3.00 


4.00 


2 . 00 


3.00 


2.25 


3.00 


42 


6.00 


6.00 


8.00 


6.00 


6.00 


7.00 


7.00 


5.00 


6.00 


6.00 


43 


6.00 


3.00 


6.00 


5.00 


5.00 


4.00 


5 . 00 


4.00 


4.00 


4.00 


44 


7.00 


6.00 


8.50 


7 . 00 


6.00 


7.00 


6.00 


8.50 


6.50 


: 6.50 


45 


7.00 


5.00 


6.00 


7.00 


6.00 


7.50 


6.00 


7.50 


6.50 


7.50 


46 


10.00 


13.00 


8.00 


10.00 


10.00 


10.50 


9.00 


9.00 


10.00 


9.00 


47 


4.00 


4.00 


3.00 


4.00 


3.00 


6.00 


4.00 


3.00 


4.00 


5.00 


48 


18.00 


15.00 


17.50 


19.10 


16.50 


19.10 


16.50 


17.00 


16.50 


18.00 


49 


57.50 


44.76 


44.70 


44.70 


44.70 


57.50 


57.50 


57.50 


44.70 


44.70 


50 



. 



15 



CALIFORNIA 



LOS ANGELES CO. 

V— L. 

\ NE»H»LL 



NO&TH ANTELOTE V/tLLET 



P, . s 



SOUTH ANTELOPE VALLEY 



i — i^ur 






r CALAMSA* ^ I J&3 




Twenty-eight Localities - Conform to PSRO Areas: 
Blue Shield handles all of l-ll; and the 
Medicare/Medi-Cal claims from 15-28 

Occidental handles non-Medi-Cal claims from 
15-28 

There are U2 screens for California as a 
result of the overlap 

(For more locality information 
see Appendix A) 



!)) <fc> \ **" 



K 



1977 PREVAILING CHARGE SUMMARY DATA CALIFORNIA PHYSICIANS SERVICE 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



CALIFORNIA 
LOCALITY DESIGNATION FOR SPECIALIST 





PROCEDURE DESCRIPTION 




PSRO-01 


PSRO-02 


PSRO-03 


PSRO-04 


PSRO-05 


PSRO-01 


PSRO-02 


PSRO-03 


PSRO-04 


PSRO-05 




01 


Initial limited office 


VISIT 














i:g. ? :;. ■■:.; • ■-.:■: ;>■ :% 


■ 






01 


02 


INITIAL COMP OFFICE 


VISIT 


56.00 


57.40 


57.40 


57.40 


56.00 


62.50 


56.00 


61 .25 


56.00 


63.80 


02 


03 


MINIMAL OFFICE VISIT 




7.00 


7.00 


7.00 


6.00 


8.00 


7.00 


6.00 


8.00 


7.00 


8.00 


03 


04 


ROUTINE BRIEF OFFICE VISIT 


10.00 


10.00 


11 .00 


10.00 


12.50 


11.50 


10.20 


12.80 


11.50 


12.80 


04 


05 


ROUTINE BRIEF HOME VISIT 


19.10 


19.10 


25.00 


19.90 


20.00 


17.90 


18.00 


17.00 


19.50 


21 .60 


05 


06 


INITIAL BRIEF HOSPITAL 


VISIT 


31 -90 


30.00 


25.00 


35.00 


31 .90 


30.00 


26.00 


31 .90 


38.00 


31 .90 


06 


07 


INITIAL COMP HOSPITAL 


VISIT 


59.50 


53.60 


63.00 


53.60 


51 .00 


66.00 


60.00 


63.80 


56.50 


63.80 


07 


08 


ROUTINE BRIEF HOSPITAL 


VISIT 


10.00 


1 1 .00 


11 .00 


12.50 


12.80 


12.00 


12.50 


15.00 


12.00 


15.00 


08 


09 


BIOPSY SKIN 




27.00 


25.00 


28.00 


25.00 


31 .90 


27.00 


29.00 


30.00 


27.00 


35.00 


09 


10 


RADICAL MASTECTOMY 




700.00 


700.00 


700.00 


700 . 00 


720.00 


625.20 


746.50 


803.90 


714.60 


900.00 


10 


1 1 


REDUCTION OF FRACTURE 




1080.80 


1080.80 


1080.80 


1080.80 


1080.80 


823.00 


84i .80 


926.00 


851 .90 


1234.70 


11 


12 


ARTHOTMY 




16-00 


17.00 


17.50 


14.00 


16.00 


12.00 


20.00 


15.50 


18.00 


25.00 


12 


13 


NEEDLE PUNCTURE OF BURSA 


16.00 


17.70 


16.00 


23. 10 


30.00 


18.60 


16.00 


18.60 


18.50 


20.90 


13 


14 


BRONCHOSCOPY 




162.00 


162.00 


162.00 


162.00 


162.00 


137.80 


1 53 . 1 


162.00 


137.00 


1 9 1 . 40 


14 


15 


THORACENTESIS 




26.80 


33.00 


32.00 


26.80 


38.30 


27.60 


32.00 


35.00 


30.60 


38.30 


15 


15 


CATHETERIZATION 




335.00 


335.00 


335.00 


335.00 


335.00 


319.00 


319.00 


3 1 9 . 00 


319.00 


300.00 


16 


17 


INSERTION OF PACEMAKER 














942.90 


942.90 


942. 90 


942.90 


942.90 


17 


18 


BLOOD TRANFUSION 




20.00 


20.00 


20.00 


20.00 


20.00 


16.00 


16.00 


16.00 


16.00 


16.00 


18 


19 


COLECTOMY 




786.00 


786.00 


786.00 


786.00 


800.00 


745.20 


795. 50 


838.30 


771 .20 


894.20 


19 


20 


APPENDECTOMY 




357.30 


363.70 


363.70 


380 . 00 


400.00 


363.70 


363. 70 


424.30 


401 .90 


484.90 


20 


21 


SIGMOIDOSCOPY 




24.60 


26.50 


25.00 


29.50 


29.50 


25.50 


27.90 


27.90 


27.90 


32.70 


21 


22 


HEMORRHOIDECTOMY 




280-00 


280.00 


287.10 


268.00 


350.00 


268.00 


268.00 


344.50 


287. 10 


357.30 


22 


23 


CHOLECYSTECTOMY 




574.20 


574.20 


600.00 


6 1 2 . 50 


701 80 


574.20 


610.60 


725.00 


612.50 


750.00 


23 


24 


REPAIR HERNIA 




360.00 


360 . 00 


360.00 


360.00 


446.60 


382.80 


382.80 


401 .90 


360.00 


446.60 


24 


25 


CYSTOSCOPY 




50.00 


50.00 


50.00 


50.00 


50.00 


42.50 


47.20 


49.80 


44.40 


56.70 


25 


26 


DILATION OF URETHRA 




16.00 


23.00 


18.00 


15.00 


17.50 


26.80 


20.00 


20.00 


20.00 


22.50 


26 


27 


PROSTATECTOMY 




700.00 


700.00 


700.00 


700.00 


700.00 


714.60 


760.00 


816.60 


816.60 


1084.60 


27 


28 


ELECTROSECTION OF PROSTATE 


800.00 


800.00 


800.00 


800.00 


800.00 


765.60 


760.00 


893.20 


765.60 


1020.80 


28 


29 


HYSTERECTOMY 




714.60 


714.60 


714.60 


714.60 


714.60 


701 .80 


689.00 


800.00 


701 .80 


893.20 


29 


30 


EXTRACTION OF LENS 




648.50 


648.50 


648.50 


648.50 


660.00 


790.10 


680.00 


740.70 


651 .80 


987.60 


30 


31 


X-RAY CHEST 




19.10 


18.00 


15-00 


19.10 


17.00 


1 8 . 00 


16.00 


20.00 


16.00 


18.50 


31 


32 


X-RAY SPINE 




27.00 


26.80 


23.00 


25.00 


26.80 


28.50 


26.00 


31 .90 


28.00 


33.00 


32 


33 


X-RAY HIP 




30-60 


27.00 


26.80 


33.20 


32.00 


30.60 


26-50 


29.00 


29.40 


28.70 


33 


34 


X-RAY STOMACH 




53.50 


53.50 


53.50 


53 . 50 


49.00 


57.00 


50.00 


57.00 


56.25 


57.40 


34 


35 


X-RAY COLON 




51 .00 


51 .00 


52.00 


43.00 


50.00 


48.00 


45.90 


53.60 


50.40 


54.20 


35 


36 


COBALT 














22.20 


22.20 


22.20 


22.20 


22.20 


36 


37 


RADIOTHcfiAP'i 














30.75 


30.75 


30.75 


30.75 


25.50 


37 


38 


HEMOGLOBIN 




3.60 


4.00 


3.50 


4.00 


5.00 


3.70 


2.00 


3.00 


3.50 


3.00 


38 


39 


WHITE CELL COUNT 




4.00 


4.00 


2.75 


5.00 


3.60 


3.00 


4.00 


3.00 


3.00 


2.50 


39 


40 


COMPLETE BLOOD COUNT 




9.60 


10.00 


12.00 


10.00 


8.00 


7.00 


12.00 


9.00 


9.50 


8.50 


40 


41 


CHOLESTERAL BLOOD COUNT 




8.00 


8.00 


11 .00 


8.00 


7.00 


7.30 


8.00 


B.OO 


10.00 


8.00 


41 


42 


HEMATOCRIT 




3.00 


4 . 00 


4-00 


5.00 


5.00 


4.50 


3.00 


4.00 


3.00 


3.00 


42 


43 


PROTHROMBIN 




5.60 


7 . 00 


6.00 


7.00 


7.00 


4.50 


7.00 


6.00 


5.00 


7.00 


43 


44 


SEDIMENTATION RATE 




4.90 


5.00 


7.00 


6.00 


6.00 


4.50 


7 . 00 


5.00 


5.75 


5.70 


44 


45 


BLOOD SUGAR 




8.00 


8.50 


10.00 


8.00 


7.00 


7.30 


■: 8.00 


8.00 


6.30 


8 . 00 


45 


46 


BUN UREA NITRATE 




8.00 


7 . 50 


8.00 


8.50 


6.00 


8.00 


8.00 


8.00 


10.00 


8.00 


46 


47 


PAP TEST 




9.00 


10.00 


10.00 


10.00 


12.50 


9.00 


9.00 


1 1 .00 


10.00 


10.00 


47 


48 


URINALYSIS 




4.00 


5.00 


5.00 


5.00 


5.00 


4.50 


5-00 


5.00 


5.00 


5.00 


48 


49 


ELECTROCARDIOGRAM 




25.00 


25.00 


25.00 


25.00 


22.00 


22.50 


25.00 


25.00 


22.50 


22.50 


49 


50 


ELECTROENCEPHALOGRAM 




60.00 


60.00 


60.00 


60.00 


60.00 


63.80 


63.80 


63.80 


63.80 


55.00 


50 



17 



1977 PREVAILING CHARGE SUMMARY DATA CALIFORNIA PHYSICIANS SERVICE 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 
PROCEDURE DESCRIPTION PSRO-06 PSRO-07 PSRO-08 PSRO-09 PSRO-10 



CALIFORNIA 
LOCALITY DESIGNATION FOR SPECIALIST 
PSRO-06 PSRO-07 PSRO-08 PSRO-09 PSRO-10 



01 

02 



INITIAL LIMITED OFFICE VISIT 
INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 

















i ■ .■': 






01 


51 .00 


50.00 


53.60 


53.60 


53.60 


60.00 


63.80 


- 53.60 


60.00 


56.00 


02 


8.00 


7.00 


7.20 


8.00 


6.00 


7.50 


7.70 


7.75 


8.00 


6.50 


03 


12.80 


11. 50 


10-00 


11 .50 


9-00 


15.00 


12.80 


9.50 


12.80 


12.50 


04 


23 . 50 


: 23.00 


19.10 


19.90 


16.00 


22.00 


24.50 


16.00 


24.50 


19.90 


05 


38.30 


36.00 


30.00 


30.00 


24.00 


35.00 


35.00 


29.25 


44.70 


38.30 


06 


50.00 


57.40 


56.00 


56.00 


53.60 


63.80 


63.80 


62.50 


63.00 


53.60 


07 


15.00 


12.80 


10.00 


12.80 


10.00 


15.00 


15.00 


9.50 


15.00 


12.80 


08 


31 .90 


31 .00 


30.00 


30.00 


26.80 


29.40 


30.00 


24.00 


27.00 


27.00 


09 


720.00 


700.00 


700.00 


720.00 


700.00 


829.40 


765.60 


630.00 


810.00 


803.90 


10 


1080.80 


1080.80 


1080.80 


1080.80 


1080.80 


1028.80 


982. 10 


823.00 


1089.60 


880.00 


11 


18.00 


15.00 


17.50 


15.00 


19.10 


16.50 


19.10 


20.00 


15.00 


20.00 


12 


22.10 


20.00 


21 .20 


19.70 


19.70 


20.00 


20.00 


18.60 


18.60 


18.60 


13 


162.00 


162.00 


162.00 


162.00 


162.00 


200.00 


191 .40 


180.00 


162.00 


150.00 


14 


31.90 


31 .90 


26-80 


30.00 


27.00 


34.50 


34.50 


30.00 


32.40 


30.80 


15 


335.00 


335.00 


335.00 


335.00 


335.00 


319.00 


300.00 


3 1 9 . 00 


300.00 


3 1 9 . 00 


16 












942.90 


942.90 


942.90 


942.90 


942.90 


17 


20.00 


20.00 


20.40 


20.00 


20.00 


16.00 


16.00 


16.00 


16.00 


16.00 


18 


786.00 


786.00 


786.00 


786.00 


786.00 


973.50 


838.30 


670.70 


838.30 


720.00 


19 


363.70 


363.70 


363.70 


350.00 


363.70 


436.40 


459.40 


400.00 


421 . 10 


360.00 


20 


29.50 


29.50 


29.50 


25.00 


29.50 


30.00 


32.70 


25.10 


27.90 


32.70 


21 


300.00 


300 . 00 


268.00 


300.00 


268.00 


357.30 


350.00 


306.20 


385.00 


295.00 


22 


600.00 


650. SO 


535.90 


612.50 


555.10 


765.60 


650.80 


555.10 


679.50 


612.50 


23 


446.60 


395.60 


350.90 


382.80 


350.90 


446.60 


401 .90 


350.90 


401 .90 


350.90 


24 


50.00 


50 . 00 


50.00 


50.00 


f 50.00 
1 18.00 


54.90 


53.90 


47.50 


51 .00 


50.00 


25 


j 18.00 


16.00 


18.00 


18.00 


19.10 


16.60 


22.50 


18.50 


20.00 


26 


» 700.00 


700.00 


700.00 


700.00 


'700.00 


861 .30 


893.20 


680.00 


893.20 


861 .30'' 


27 


800.00 


800.00 


800.00 


800.00 


800.00 


900.00 


829.40 


800.00 


842.20 


800.00 


28 


717.00 


714.60 


714.60 


714 . 60 


714.60 


893.20 


733.70 


689.00 


765.60 


765.60 


29 


650.00 


648.50 


648.50 


660 . 00 


648.50 


839.50 


839.50 


790. 10 


790. 10 


691 .30 


30 


18.00 


18.00 


19.10 


17.00 


16.00 


19. tO 


17.00 


16.20 


16.25 


18.00 


31 


' 26.80 


30.00 


28.00 


30.00 


* 26.80 


33.20 


42.00 


29.75 


28.50 


33.20 


32 


32.00 


: ; 27.00 


32.00 


32.00 


? 32.00 


30.60 


27.00 


26.50 


27.00 


25.00 


33 


62.00 


62 . 50 


53.50 


53.50 


53.50 


61.25 


54.20 


48.50 


57.00 


57.00 


34 


5 1 . 00 


: 53.60 


51.00 


51 .00 


51 .00 


56.00 


51.00 


48.60 


50.00 


43.50 


35 












22.20 


22.20 


22.20 


22.20 


22.20 


36 












30.75 


30.75 


30.75 


30.75 


30.75 


37 


5.00 


4.00 


3.90 


3.50 


4.00 


3.50 


4.25 


4.00 


3.50 


4.00 


38 


3.75 


3.00 


4.00 


4.00 


3.00 


3.00 


3.00 


4.00 


3.00 


3.00 


39 


8.00 


10.80 


15.00 


9.25 


8.00 


9.00 


10.00 


10.00 


9.00 


9.50 


40 


8.00 


8.75 


8.00 


7.00 


' 7 . 00 


8.00 


8.50 


8.00 


6.00 


8.00 


41 


3.00 


4.00 


^.90 


4.00 


4.oO 


4.50 


4.00 


4.00 


3.00 


4.00 


42 


5.50 


8.00 


8.60 


7.00 


5.00 


7.50 


7.00 


6.00 


6.00 


6.00' 


43 


6.00 


6.00 


5.90 


5.00 


4 . 00 


6.00 


6.50 


5.00 


5.00 


5.70 


44 


7.20 


8.00 


:,,:-. 8.00 


i; 7.00 


7.75 


8.00 


8.00 


9.25 


8.00 


■H: 8 . 00 


45 


7.00 


8.00 


8.00 


7.00 


7.00 


8.50 


8.75 


8.00 


8.00 


8.00 


46 


8.00 


9.50 


8.00 


8.00 


9.50 


8.00 


9.00 


8.50 


8.00 


9.00 


47 


5.00 


5.00 


4.75 


5.00 


5.00 


5.00 


5.00 


4.50 


4.50 


4.00 


48 


21 .00 


25.00 


26.80 


25.00 


25.00 


22.00 


25.00 


25.00 


23.00 


23.00 


49 


60.00 


60.00 


60.00 


60.00 


60.00 


63.80 


63.80 


63.80 


63.80 


63.80 


50 



18 



53.60 
7.00 
9.00 
19.10 
30.00 
53.60 



.00 



1977 PREVAILING CHARGE SUMMARY DATA CALIFORNIA PHYSICIANS SERVICE 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 
PROCEDURE DESCRIPTION PSRO-11 PSRO-12 PSRO-13 PSRO-14 PSRO-15 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 C03ALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 3 

43 PROTHROMBIN 7 

44 SEDIMENTATION RATE 5 

45 BLOOD SUGAR 7. 

46 BUN UREA NITRATE 10.00 

47 PAP TEST 8.00 

48 URINALYSIS 4.00 

49 ELECTROCARDIOGRAM 26.80 

50 ELECTROENCEPHALOGRAM 60.00 



9. 

27.00 

700.00 

1080.80 

20.00 

17.70 

162.00 

26.80 

335.00 

20.00 

786.00 

363.70 

26.50 

300.00 

574.20 

350.00 

50.00 

26.80 

700.00 

800.00 

714.60 

648.50 

17.90 

25.50 

32.00 

53.50 

51 .00 



3.00 

3.20 

10.00 

8.00 



50.00 
7.00 
10.00 
17.90 
30.00 
57.40 
10.80 
30.00 

700.00 

1080.80 

17.00 

19.70 

162.00 
30.00 

350.00 

20.00 

786.00 

363.70 

27.60 

306.20 

580.00 

350.00 

50.00 

18.00 

700.00 

800.00 

720.00 

656.00 

16.00 

26.50 

30.00 

52.00 

51-00 



00 
50 



8.50 



00 
00 
00 
00 



00 
00 
00 
00 
00 
00 



8.50 

4.00 

23.00 

60.00 



51 .00 
8.00 
8 . 90 
19.10 
28.70 
59.30 
10.20 
28.70 

700.00 

1080.80 

15.00 

19.70 

162.00 
28.70 

335.00 

20.00 

786.00 

363.70 

29.50 

268.00 

574.20 

312.60 

50.00 

20.00 

700.00 

800.00 

630.00 

648.50 

16.00 

24.00 

32.00 

53-50 

51.00 



4.00 

4.00 

9.00 

8.00 

4.00 

7.00 

6.00 

8.00 

8.00 

12.00 

5.00 

24.00 

60.00 



48.00 
8.90 
10.00 
19. 10 
30.00 
61 .25 
10.00 
31 .90 

700.00 

1080.80 

19. 10 

18.60 

180.00 
31 -90 

335.00 

20.00 

786.00 

400.00 

29.50 

300.00 

574.20 

331 .80 

50.00 

23.00 

700.00 

800 . 00 

714.60 

648 . 50 

19. 10 

28.70 

35.70 

53.50 

53.60 



4.00 
4.00 

10.80 
9.00 
4.00 
8.00 
6.00 
9.00 
9.00 

10.00 
5.00 

27.00 

60.00 



63.80 

8 . 00 

10-00 

19.10 

30.00 

60.00 

12.00 

35.00 

800.00 

1 110. 10 

18.00 

1 8 . 50 

1 80 . 00 

31 -90 

331 .00 

800.00 

16.00 

888. 10 

408.30 

27.00 

300.00 

652.00 

401 -90 

55.50 

20.00 

925. 10 

1000.00 

900.00 

800.00 

20.00 

33.20 

35.10 

63.00 

42.00 

27.00 

35.00 

6.00 

3.00 

10.00 

8.50 

5.00 



00 
50 



8.00 

8.50 

15.00 

4.80 

25.00 

60.00 



CALIFORNIA 
LOCALITY DESIGNATION FOR SPECIALIST 
PSRO-11 PSRO-12 PSRO-13 PSRO-14 PSRO-15 



53.60 

6.00 

10.20 

12.00 

30.00 

53.60 

10.20 

30.00 

625.20 

823.00 

20.00 

18.00 

180.00 

27.00 

3 1 9 . 00 

942.90 

16.00 

745.20 

357.30 

27.90 

268.00 

535.90 

350.00 

45.00 

27.00 

800.00 

714.60 

765.60 

888.90 

17.90 

33.00 

25.50 

51 .00 

51 .00 

22.20 

30.75 

2.75 

3.00 

8.40 

7.00 

3.00 

5.60 

5.70 

6.00 

8.00 

9.00 

4.50 

24.00 

60.00 



65.00 

: 7.00 

12.00 

19.50 

30.00 

63.80 

10.00 

30.00 

750.00 

823.00 

18.00 

15.00 

180.00 

31 .90 

350.00 

942. 90 

16.00 

838.30 

380.00 

27.90 

280.00 

638-00 

357.30 

50.00 

28.00 

893.20 

800.00 

720.00 

790. 10 

21 .00 

45.50 

30.60 

50.00 

48.00 

22.20 

30.75 

5.00 

3.50 

10.00 

7.00 

5.00 

6.00 

6.00 

7.00 

7.00 

8.00 

4.20 

21 .00 

63.80 



63.80 

7.70 

10. 20 

19.90 

26.80 

60.00 

1 1 .50 

30.00 

803.90 

1028.80 

20-00 

18.60 

180.00 

34.50 

319.00 

942.90 

16.00 

838.30 

410.00 

24.20 

344.50 

600.00 

357.30 

4 7.20 

22.50 



30 
70 



861 

867. 

765.60 

691 .30 
18.00 
33.00 
30.00 
57.00 
51 .00 
22.20 
30.75 



00 
00 
50 



8.00 
4.00 
7.00 
5.70 
8.00 
8.00 



56.00 

8.00 

10.00 

19.90 

28.80 

57.60 

12.50 

31 .90 

720.00 

972.70 

20-00 

18.60 

180.00 

34.50 

319.00 

942.90 

16.00 

804.80 

380.00 

27.90 

316.00 

574.20 

344.50 

42.50 

19. 10 

720.00 

720.00 

638.00 

730.90 

18.00 

27.00 

36.00 

54.00 

45.00 

23.00 

32.25 

3.60 

3.25 

10.00 



00 
25 
30 
00 



9.00 
8.25 



00 
00 



00 
50 



23.00 
63.80 



28.80 
63.80 



65.00 

7.00 

12.00 

24.00 

31 .90 

65.00 

15.00 

30.00 

741 .00 

902.00 

15.00 

29.50 

150.00 

36.00 

350.00 

840.00 

20.00 

800.00 

408.30 

34.50 

315.00 

660.00 

385.00 

50.00 

20.00 

800.00 

867.70 

800.00 

770.00 

16.00 

28.00 

29.00 

50.75 

45.90 

28.00 

35.00 

4.25 

3.20 

8.40 

7.00 

3.20 

6.00 

5 . 00 

7.00 

7.00 

10.00 

5.00 

24.00 

60.00 



Ot 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



19 



1977 PREVAILING CHARGE SUMMARY DATA CALIFORNIA PHYSICIANS SERVICE 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 
PROCEDURE DESCRIPTION PSRO-16 PSRO-17 PSRO-18 PSRO-19 PSRO-20 



CALIFORNIA 
LOCALITY DESIGNATION FOR SPECIALIST 
PSRO-16 PSRO 17 PSRO-18 PSRO-19 PSRO-20 



01 


INITIAL LIMITED OFFICE VISIT 


























01 


02 


INITIAL CCMP OFFICE VISIT 


50.00 


63 


.00 


60.00 


57 


.40 


50.00 


60.00 


65.00 


63.80 


63.80 


60.00 


02 


03 


MINIMAL OFFICE VISIT 


6.00 


6 


.00 


8.50 


7 


.00 


8.00 


6.50 


8.20 


8.00 


7.00 


7.00 


03 


04 


ROUTINE BRIEF OFFICE VISIT 


10.00 


10 


,20 


12.00 


12 


.00 


12.00 


12.00 


15.00 


15.00 


15.00 


15.00 


04 


05 


ROUTINE BRIEF HOME VISIT 


17.50 


17 


,00 


22.50 


20 


,00 


20.00 


20.00 


20.00 


30.00 


25.00 


25.00 


05 


06 


INITIAL BRIEF HOSPITAL VISIT 


32.50 


31 


.90 


44.70 


42 


.00 


44. 70 


30.00 


30.00 


44.70 


40.00 


44.70 


06 


07 


INITIAL COMP HOSPITAL VISIT 


60.00 


60 


00 


60.00 


60 


.00 


60.00 


60.00 


65.00 


63.80 


63.80 


63.80 


07 


08 


ROUTINE BRIEF HOSPITAL VISIT 


12.00 


12 


,00 


15.00 


15 


.00 


17.00 


12.80 


13.00 


18.00 


17.00 


19.10 


08 


09 


BIOPSY SKIN 


30.00 


30 


,00 


35.00 


30 


.00 


30.00 


32.50 


30.00 


30.00 


30.00 


3 3.00 


09 


10 


RADICAL MASTECTOMY 


900.00 


800 


,00 


829.40 


800 


.00 


900.00 


900.00 


760.00 


990.00 


900.00 


900.00 


10 


1 1 


REDUCTION OF FRACTURE 


11 10. 10 


mo 


, 10 


1110. 10 


1100 


. 10 


1 1 10. 10 


924.00 


1069.50 


1120.00 


1176.50 


1166.80 


11 


12 


ARTHQTMY 


20.40 


20 


.00 


16.00 


18 


.00 


20.40 


15.00 


15.00 


16.50 


20.00 


15.00 


12 


13 


NEEDLE PUNCTURE OF BURSA 


18.80 


18 


50 


20.00 


16 


.70 


23.10 


24.60 


24.60 


24.60 


20.00 


20.00 


13 


14 


BRONCHOSCOPY 


180.00 


180 


.00 


180.0C 


• 80. 


.00 


1 80 . 00 


172.30 


172.30 


165.00 


180.00 


180.00 


14 


15 


THORACENTESIS 


35.00 


32 


.50 


40.0 


35 


.00 


36.00 


36.00 


44.70 


44.70 


40.00 


45.00 


15 


16 


CATHETERT7ATI0N 


331 .00 


331 


.00 


350. 00 


331 


.00 


331 .00 


350.00 


350.00 


350.00 


350.00 


350.00 


16 


17 


INSERTION OF PACEMAKER 


800.00 


800 


,00 


800.00 


740 


. 10 


740. 10 


960.00 


960.00 


960.00 


797.50 


797.50 


17 


18 


BLOOD TRANFUSION 


16.00 


16 


,00 


16.00 


16 


.00 


16.00 


20.00 


20.00 


20.00 


20.00 


20.00 


18 


19 


COLECTOMY 


888. 10 


888 


, 10 


888. 10 


888 


. 10 


888. 10 


900.00 


850.00 


960.00 


982.50 


1000.00 


19 


20 


APPENDECTOMY 


403.75 


408 


,30 


430.00 


520 


,00 


408. 30 


440.00 


459.40 


459.40 


459.40 


475.00 


20 


21 


SIGMOIDOSCOPY 


27.75 


30 


,00 


35.00 


35 


.00 


32.40 


30.00 


34.50 


27.00 


30.00 


35.40 


21 


22 


HEMORRHOIDECTOMY 


357.30 


360 


,00 


357.30 


357 


30 


385.00 


300.00 


350.00 


382.80 


382.80 


400.00 


22 


23 


CHOLECYSTECTOMY 


600.00 


655 


,00 


733.70 


780 


,00 


660.00 


725.00 


701.80 


750.00 


765.60 


797.50 


23 


24 


REPAIR HERNIA 


407.50 


360 


.00 


450.00 


491 


,30 


450.00 


420.00 


432.00 


450.00 


500.00 


495.00 


24 


25 


CYSTOSCOPY 


55.50 


55 


.50 


55.50 


60 


.00 


55.50 


50.00 


54.60 


60.00 


50.00 


60.00 


25 


26 


DILATION OF URETHRA 


18.00 


25 


.60 


26.80 


16 


.00 


20.00 


20.00 


20.00 


20.00 


27.00 


21 .70 


26 


27 


PROSTATECTOMY 


925.10 


925 


. 10 


925. 10 


925 


. 10 


925.10 


990.00 


1000.00 


1000.00 


1071 .80 


1000.00 


27 


28 


ELECTROSECTION OF PROSTATE 


1000.00 


1000 


.00 


1000.00 


100 


.00 


1000.00 


900.00 


816.60 


1000.00 


960.00 


1000.00 


28 


29 


HYSTERECTOMY 


900.00 


900 


,00 


900.00 


900 


.00 


8 1 . 00 


861 .30 


861 .30 


800.00 


900.00 


975.00 


29 


30 


EXTRACTION OF LENS 


800.00 


800 


.00 


800.00 


800 


.00 


800.00 


800.00 


850.00 


950.00 


870.00 


1100:00 


30 


31 


X-RAY CHEST 


19.10 


20 


.40 


20.00 


19 


. 10 


18.00 


17.50 


19.10 


15.00 


23.00 


17.50 


31 


32 


X-RAY SPINE 


26.00 


33 


. 10 


38.50 


31 


.90 


35.00 


28.00 


33-60 


32.00 


33.60 


32.50 


32 


33 


X-RAY HIP 


32.00 


34 


.00 


31.50 


26 


.00 


30.60 


28.00 


33.60 


28.00 


33.50 


28.00 


33 


34 


X-RAY STOMACH 


48.00 


63 


.00 


65-00 


55. 


00 


46-00 


55.00 


70.00 


50.00 


56.00 


59.00 


34 


35 


X-RAY COLON 


50.00 


58 


.00 


51 .00 


58. 


,00 


48.00 


48.00 


57 . 40 


52 . 00 


54.00 


50.00 


35 


36 


COBALT 


27.00 


27, 


00 


27.00 


27 


,00 


27.00 


28.00 


28.00 


28.00 


28.00 


28.00 


36 


37 


RADIOTHERAPY 


35.00 


35. 


00 


35.00 


35 


,00 


35.00 


35.00 


35.00 


35.00 


35.00 


35.00 


37 


38 


HEMOGLOBIN 


5.00 


4. 


00 


4.00 


3 


,00 


5.00 


3.00 


4.50 


3.00 


4.50 


6.00 


38 


39 


WHITE CELL COUNT 


4.00 


5. 


00 


4.00 


4 


,00 


4.00 


3.00 


4.50 


2.50 


3.50 


5.00 


39 


40 


COMPLETE BLOOD COUNT 


10.00 


10. 


00 


10.00 


10 


,00 


9.00 


9.00 


8.50 


8.25 


8.50 


8.50 


40 


41 


CHOLESTERAL BLOOD COUNT. 


8 . 00 


8. 


00 


:: 8.00 


8 , 


,00 


8-00 


6.00 


8.00 


7.00 


7.50 


8.00 


41 


42 


HEMATOCRIT 


4.00 


4. 


00 


3.00 


4, 


.00 


3.50 


3.00 


4.50 


2.00 


4.50 


3.00 


42 


43 


PROTHROMBIN 


7.00 


9. 


00 


7.00 


7 


00 


7.50 


6.00 


8.00 


6 . 00 


6.00 


7.00 


43 


44 


SEDIMENTATION RATE 


5.00 


5. 


00 


6.00 


5. 


00 


6.00 


5.00 


6.00 


5.00 


5-00 


5.00 


44 


45 


BLOOD SUGAR 


8.00 


9. 


00 


.-:■, 8.00 


8 . 


00 


8. 00 


8.00 


8.00 


i;: 7.00 


8.00 


8 . 00 


45 


46 


BUN UREA NITRATE 


7.00 


9. 


00 


8.00 


10. 


00 


8. 00 


7.75 


8.00 


8.00 


7.00 


7.50 


46 


47 


PAP TEST 


10.00 


13. 


00 


10.00 


10, 


00 


12.00 


10.00 


11 .00 


10.00 


10.00 


10.00 


47 


48 


URINALYSIS 


5.00 


5. 


00 


5.00 


5, 


00 


5.00 


5.00 


5.20 


5.00 


5.00 


5.00 


48 


49 


ELECTROCARDIOGRAM 


25.00 


27. 


00 


25.00 


25. 


00 


25.00 


24.00 


28.00 


25.00 


25.00 


25.00 


49 


50 


ELECTROENCEPHALOGRAM 


63.60 


60. 


00 


53.60 


53. 


60 


53.60 


60.00 


60.00 


55.00 


65.00 


55.00 


50 



20 



1977 PREVAILING CHARGE SUMMARY DATA 



CALIFORNIA PHYSICIANS SERVICE 



CALIFORNIA 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 



PSRO-21 PSR0-22 PSRO-23 PSRO-24 PSRO-25 



PSRO-21 PSRO-22 PSRO-23 PSRO-24 PSRO-25 



01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECT- or oIOGRAM 

50 ELECi PHALOGRAM 



* . ■ ■ ' ■ ■■■:,' ■ 



61.25 

10.00 

12.00 

25.00 

44.70 

60.00 

15.00 

35.00 

800.00 

11 10.10 

20.00 

20.80 

180.00 

38.30 

331 .00 

800.00 

16.00 

888. 10 

408.30 

32.40 

360.00 

765.60 

450.00 

60.00 

16.00 

925. 10 

1000.00 

900.00 

800.00 

18.00 

30.00 

32.00 

63.80 

55.00 

27.00 

35.00 

5.00 

3.50 

9.50 

9.00 

4.00 

8.00 

5.00 

8-00 

9.00 

10.00 

5.00 

27.00 

53.60 



60.00 

8.00 

12.00 

25.00 

44.70 

63.80 

15.00 

34.50 

900. 00 

1110.10 

20.40 

18.50 

180.00 

38.00 

331 .00 

800.00 

16.00 

960.00 

475.00 

35.00 

364.50 

750. CO 

450.00 

55.50 

25.60 

925. 10 

1000.00 

900 . 00 

850.00 

17.00 

34.50 

25.50 

60.00 

62.00 

27.00 

35.00 

5.00 

5. 

11 



.00 
.00 



8.50 
4.00 
8.00 
6.00 

10.00 
9.00 

13.00 
6.00 

26.80 

53.60 



.00 
10 



63.80 

8.00 

12.00 

20.00 

44.70 

60.00 

15.00 

31 .90 

800.00 

1110. 10 

18.00 

20.00 

180.00 

36.00 

331 

740. 

16.00 

900.00 

427.00 

30.60 

400.00 

701 .80 

459-40 

60.00 

20.00 

925.10 

1000.00 

900.00 

800.00 

18 60 

30.00 

30.00 

60-00 

50.00 

27.00 

35.00 

4.00 

4.00 

9. 

9. 

5. 



.00 
.00 
-00 



8.00 

5.00 

8.00 

9.00 

15.00 

5.00 

25.00 

60.00 



45.00 

8.00 

1 . 00 

18.00 

44.70 

60.00 

15.00 

31 .90 

900 . 00 

1100. 10 

15.00 

20.40 

180.00 

35.00 

331 .00 

800.00 

16.00 

888 . 10 

455.00 

27.75 

357.30 

765.60 

405 . 00 

46.30 

24.00 

925. 10 

1000.00 

900 . 00 

800.00 

17.00 

28.00 

30.60 

60.80 

55.00 

27.00 

35.00 



5 
5 
9 
11 
4 
7 
5 



00 
00 
60 
00 
00 
00 
00 



52.00 

12.80 

12.50 

25.00 

35.00 

67.00 

15.00 

30.00 

900.00 

1200.00 

20.40 

25.90 

1 80 . 00 

38.00 

331 .00 

740. 10 

16.00 

960.00 

475.00 

25.00 

364.50 

750.00 

550.00 

55 . 50 

25.60 

925. 10 

1 000 . 00 

900.00 

850.00 

20.00 

31 .00 

30.00 

63.00 

58 . 00 

27.00 

35.00 

4. 

5. 

9. 



• 00 
.00 
.50 



8.50 



00 
00 
00 



8.00 

8.00 

15.00 

4.80 

25.00 

53.60 



8.00 

8.50 

16.00 

5.00 

25.00 

60.00 



60.00 

6.00 

14.00 

24.00 

40.00 

63.80 

15.00 

33.00 

918.70 

1193.10 

20.00 

25.00 

200.00 

44.70 

350.00 

960.00 

20.00 

1000.00 

459.40 

35.00 

382.80 

760.00 

500.00 

63.00 

19.10 

900.00 

950.00 

950.00 

800.00 

: 16.50 

36.00 

35.00 

59.00 

56.00 

28.00 

35.00 

4.00 

5.00 

8.00 

7.50 

3.75 

7.00 

5.50 

8.00 

8.50 

10.00 

5.00 

25.00 

55.00 



63.80 

8- 00 

16.00 

29.00 

44.70 

63.80 

20.00 

35.00 

1084.60 

1283.40 

25.00 

24.60 

180.00 

45.00 

350.00 

960.00 

20.00 

1200. 00 

500.00 

40.00 

400.00 

861.30 

550.00 

69.50 

20.00 

1000.00 

1 100.00 

893.20 

1100.00 

16.00 

39.00 

26.25 

65.00 

55.00 

28.00 

35.00 

4.00 

4.00 

9.50 

8.00 

4.00 

7.00 

6.00 

8 . 00 

9.00 

10.00 

6.00 

25.00 

70.00 



. . .■ 

. 65.00 

7.50 

12.00 

25.00 

50.00 

75.00 

19. 10 

33.00 

900.00 

1176.50 

20.00 

24.60 

180.00 

39.60 

350.00 

797.50 

20.00 

1000.00 

475.00 

39.30 

385.00 

765.60 

500.00 

60.00 

19.00 

1000.00 

1000.00 

900.00 

900.00 

21 .00 

41.50 

30-00 

58.00 

55.00 

28.00 

35.00 

3.00 

4.00 

10.00 

7.50 

4.00 

7.00 

5.00 

8.00 

8.00 

13.00 

5.00 

25.00 

70.00 



63.80 

10.00 

12.00 

20.00 

35.00 

67.00 

16.00 

38.30 

850.00 

1200.00 

19.50 

20.00 

150.00 

45.90 

350.00 

920.00 

20.00 

1000.00 

500.00 

35.40 

400.00 

798.00 

480.00 

50.00 

19. 10 

1000.00 

1000.00 

900.00 

1000.00 

18.50 

39.00 

32.00 

68.30 

55.00 

28.00 

35.00 

4.00 

3.00 

8.00 

7.50 

4.00 



75 

00 



8.00 

7.50 

12.00 

4.00 

25.00 

55.00 



63 

10 

15 

25 

50 

65 

20 

35 

1250 

1340 

16 

20 

180 

40 

300 

797 

20 

1200 

500 

35 

450 

900 

600 

66 

18 

1100 

1100 

957 

1000 

20 

30 

30 

64 

55 

28 

35 

3 

4. 

10 

8 

4. 

8. 

6. 

8, 

8. 

10. 

5. 

25. 

70. 



.80 
.00 
.00 
.00 
.00 
. 10 
.00 
.00 
.00 
.80 
.00 
.00 
.00 
.00 
.00 
.50 
.00 
.00 
.00 
.00 
.00 
.00 
.00 
.00 
.00 
.00 
.00 
.00 
.00 
.00 
.00 
.50 
.40 
.00 
.00 
.00 
50 
00 
00 
00 
00 
00 
00 
00 
00 
50 
00 
00 
00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



21 



1977 PREVAILING CHARGE SUMMARY DATA 



CALIFORNIA PHYSICIANS SERVICE 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 


PSRO-26 


PSR0-27 


01 INITIAL LIMITED OFFICE VISIT 






02 INITIAL COMP OFFICE VISIT 


60.00 


52.00 


03 MINIMAL OFFICE VISIT 


9.00 


9.60 


04 ROUTINE BRIEF OFFICE VISIT 


12.00 


10.20 


05 ROUTINE BRIEF HOME VISIT 


25.50 


18.00 


06 INITIAL BRIEF HOSPITAL VISIT 


44.70 


31 .90 


07 INITIAL COMP HOSPITAL VISIT 


63.80 


60.00 


08 ROUTINE BRIEF HOSPITAL VISIT 


16.00 


12.00 


09 BIOPSY SKIN 


30.00 


24.00 


10 RADICAL MASTECTOMY 


800.00 


800.00 


11 REDUCTION OF FRACTURE 


1 110. 10 


1110.10 


12 ARTHOTMY 


20.00 


16.00 


13 NEEDLE PUNCTURE OF BURSA 


20.00 


18.00 


14 BRONCHOSCOPY 


180.00 


180.00 


15 THORACENTESIS 


50.00 


32.50 


16 CATHETERIZATION 


350.00 


331 .00 


17 INSERTION OF PACEMAKER 


800.00 


750.00 


18 BLOOD TRANFUSION 


16.00 


16.00 


19 COLECTOMY 


999. 10 


888. 10 


20 APPENDECTOMY 


427.50 


400-00 


21 SIGMOIDOSCOPY 


30.00 


25.00 


22 HEMORRHOIDECTOMY 


357.30 


357.30 


23 CHOLECYSTECTOMY 


700.00 


600.00 


24 REPAIR HERNIA 


450.00 


360.00 


25 CYSTOSCOPY 


55.00 


55.50 


26 DILATION OF URETHRA 


25.00 


25.60 


27 PROSTATECTOMY 


1000.00 


925. 10 


28 ELECTROSECTION OF PROSTATE 


893.20 


1000.00 


29 HYSTERECTOMY 


840.00 


900.00 


30 EXTRACTION OF LENS 


800.00 
18-50 


800.00 


31 X-RAY CHEST 


1 7 . 90 


32 X-RAY SPINE 


31 .90 


31.90 


33 X-RAY HIP 


31 -90 


30-00 


34 X-RAY STOMACH 


62.50 


63.00 


35 X-RAY COLON 


57.40 


58 .00, 


36 COBALT 


27.00 


27.00 


37 RADIOTHERAPY 


35.00 


35.00 


38 HEMOGLOBIN 


4.50 


4.00 


39 WHITE CELL COUNT 


4.00 


4.50 


40 COMPLETE BLOOD COUNT 


10.00 


8.00 


41 CHOLESTERAL BLOOD COUNT 


9.00 


7.50 


42 HEMATOCRIT 


4.00' 


4.00 


43 PROTHROMBIN 


8.00 


5.00 


44 SEDIMENTATION RATE 


7.00 


5.00 


45 BLOOD SUGAR 


8.00 


7.50 


46 BUN UREA NITRATE 


8.00 


7.00 


47 PAP TEST 


10.00 


10.00 


48 URINALYSIS 


5.00 


4.00 


49 ELECTROCARDIOGRAM 


25.00 


25.00 


50 ELECTROENCEPHALOGRAM 


53.60 


53.60 



CALIFORNIA 
LOCALITY DESIGNATION FOR SPECIALIST 

PSRO-28 



PSRO-28 


PSRO-26 


PSR0-2 


60.00 


63.80 


63.80 


6.00 


7.00 


5.00 


11 .00 


15.0Q 


10.00 


20.00 


29.00 


25.00 


34.50 


40.00 


35.00 


60.00 


75.00 


63.80 


12.80 


19.10 


12.00 


30.00 


33.00 


35.00 


800.00 


1000.00 


770.00 


1 1 10. 10 


1176.50 


1097.20 


20-00 


15.00 


15.00 


18.50 


24.60 


23.60 


180.00 


175.00 


160.80 


32.50 


44.70 


32.00 


350.00 


350.00 


350.00 


800.00 


960.00 


7 9 7.50 


16.00 


20.00 


20.00 


898. 10 


970.00 


900.00 


408.30 


459.40 


459.40 


30 . 00 


32.40 


34.50 


350.00 


382.80 


350.00 


693.00 


740.10 


720.00 


4 48.00 


459.40 


433.80 


55.50 


59.60 


50.00 


24.00 


20.00 


24.00 


925. 10 


1000.00 


900.00 


1000.00 


995.30 


893.20 


900.00 


893.20 


850.00 


800-00 


850.00 


800.00 


1 8 . 00 


17.00 


16.00 


27.00 


44.70 


30.00 


31 -90 


30.00 


28. 10 


55.00 


60.00 


55. OO 


60 . 00 


35' V\J ** o • W 


27.00 


28.00 


28.00 


35.00 


35.00 


35.00 


4.00 


3.75 


4.00 


3.50 


5.00 


3.00 


10.00 


9.00 


7.50 


9.00 


8.00 


7.00 


4.20 


4.00 


3.60 


7.50 


6.00 


5.00 


6.00 


5.50 


6.00 


8.00 


7.50 


6.00 


9.00 


7.50 


7.00 


12.50 


9.50 


9.00 


5.00 


5.50 


4.50 


25.00 


25.00 


24.00 


53.60 


70.00 


60.00 





01 


61.00 


02 


8.00 


03 


1 1 .00 


04 


20.00 


05 


31 .90 


06 


65.00 


07 


12.00 


08 


32.00 


09 


900.00 


10 


1100.00 


11 


20.00 


12 


22. 10 


13 


172.00 


14 


36.00 


15 


350.00 


16 


960.00 


17 


20.00 


18 


900.00 


19 


448.50 


20 


30.00 


21 


344.50 


22 


725.00 


23 


450.00 


24 


54.60 


25 


18.00 


26 


900.00 


27 


900.00 


28 


775.00 


29 


840.00 


30 


17.00 


31 


28.00 


32 


28.00 


33 


60.00 


34 


57.40 


35 


28.00 


36 


35.00 


37 


3.00 


38 


3.20 


39 


8.50 


40 


7.00 


41 


3.50 


42 


6.00 


43 


4.75 


44 


a 7.00 


45 


7.00 


46 


10.00 


47 


5.00 


48 


25.00 


49 


60.00 


50 



22 



1977 PREVAILING CHARGE SUMMARY DATA 



OCCIDENTAL LIFE INSURANCE Co. 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



CALIFORNIA 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 



01 
02 



INITIAL LIMITED OFFICE VISIT 
INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



PSRO-15 


PSRO-16 


PSRO-17 


PSRO-18 


PSRO-19 


PSRO-15 


PSRO-16 


PSRO-17 


PSRO-18 


PSRO-19 




63.80 


50.00 


63. 00 


60.00 


57.40 


65.00 


60.00 


65.00 


63.80 


63.80 


01 

02 


8.00 


6.00 


6.00 


8.50 


7.00 


7.0Q 


6.50 


8.20 


8.00 


7.00 


03 


10.00 


10.00 


10.20 


12.00 


12.00 


12.00 


12-00 


1 5 . 00 


15.00 


15.00 


04 


19.10 


i 17.50 


17.00 


22.50 


20.00 


24.00 


20.00 


20.00 


30.00 


25.00 


05 


30.00 


32.50 


31 .90 


44.70 


42.00 


31 .90 


30.00 


30.00 


44. 70 


40.00 


06 


60.00 


60.00 


60.00 


60.00 


60.00 


65.00 


60.00 


65.00 


63.80 


■ 63.80 


07 


12.00 


12.00 


12.00 


15.00 


15.00 


15.00 


12.80 


13.00 


18.00 


17.00 


08 


35.00 


30.00 


30.00 


'35.00 


30.00 


30.00 


32.50 


30.00 


30.00 


30.00 


09 


891 .00 


900 . 00 


800.00 


829.40 


800.00 


741 .00 


900.00 


760.00 


990.00 


900.00 


10 


1110.10 


1110.10 


11 10-10 


1110.10 


1110.10 


972.70 


924.50 


1069.50 


1120.00 


1176.50 


1 1 


18.00 


20.40 


20-00 


16.00 


18.00 


20.00 


15.00 


15.00 


16.50 


20.00 


12 


18.50 


18.80 


18.50 


20 . 00 


16.70 


29.50 


24.60 


24.60 


24.60 


20.00 


13 


180.00 


180.00 


180.00 


180.00 


1 80 . 00 


150.00 


172.30 


172.30 


165.00 


180.00 


14 


31 .90 


35.00 


32.50 


40.00 


35.00 


36.00 


36.00 


44.70 


44.70 


• 40.00 


15 


331 .00 


331 .00 


331 .00 


350.00 


331 .00 


350.00 


350.00 


350.00 


350.00 


- 350.00 


16 


800.00 


800.00 


800.00 


800 . 00 


740. 10 


840.00 


960.00 


960.00 


960.00 


797.50 


17 


16.00 


16.00 


16.00 


16.00 


16.00 


20.00 


20.00 


20.00 


20.00 


20.00 


18 


888. 10 


888. 10 


888. 10 


888. 10 


888. 10 


800.00 


900.00 


850.00 


960.00 


982.50 


19 


408.30 


403.75 


408.30 


430.00 


520.00 


408.30 


440.00 


459.40 


459.40 


459.40 


20 


27.00 


27.75 


30.00 


35.00 


35.00 


34.50 


30.00 


34.50 


27.00 


30.00 


21 


300.00 


357.30 


360.00 


357 . 30 


357.30 


315.00 


300.00 


350.00 


382.80 


, 382.80 


22 


652.00 


600 . 00 


655.00 


733.70 


780-00 


660.00 


725.00 


701 .80 


750.00 


' 765.60 


23 


401 .90 


407 . 50 


360.00 


450 . 00 


491 .30 ■ 


385.00 


420.00 


432.00 


450.00 


500.00 


24 


55.50 


55.50 


55.50 


55.50 


60.00 §f! 


50.00 


50.00 


54.60 


60.00 


50.00 


25 


20.00 


18.00 


25.60 


26.80 


16.00 


20.00 


20.00 


20.00 


20.00 


27.00 


26 


925.10 


925. 10 


925. 10 


925. 10 


925.10 


800.00 


990.00 


1000.00 


1000.00 


1071 .80 


27 


1000.00 


1000.00 


1000.00 


1000.00 ■ 


000.00 


867.70 


900.00 


816.60 


1000.00 


960.00 


28 


900.00 


900.00 


900.00 


900 . 00 


900.00 


800.00 


861 .30 


861 .30 


800.00 


900.00 


29 


800.00 


800.00 


800.00 


800 . 00 


800.00 


770.00 


800.00 


850.00 


950.00 


870.00 


30 


20.00 


19.10 


20.40 


20.00 


19. 10 


1 6 . 00 


17.50 


19. 10 


15.00 


23.00 


31 


33-20 


26.00 


33.10 


38 .50 


31 .90 


28.00 


28.00 


33.60 


32.00 


33.60 


32 


35. 10 


32.00 


34.00 


31 .50 


26.00 


29.00 


28.00 


33.60 


28.00 


33.60 


33 


63.00 


48.00 


63.00 


65.00 


55.00 


50.75 


55.00 


70.00 


50.00 


5S.00 


34 


42.00 


50.00 


58.00 


51 .00 


58.00 


45.90 


48.00 


57.40 


52.00 


54.00 


35 


27.00 


27.00 


27.00 


27.00 


27.00 


28.00 


28.00 


28.00 


28.00 


28.00 


36 


35.00 


35.00 


35.00 


35.00 


35.00 


35.00 


35.00 


35.00 


35.00 


35. OC 


37 


6.00 


5.00 


4.00 


4.00 


3.00 


4.25 


3.00 


4.50 


3.00 


4.50 


38 


3.00 


4.00 


5.00 


4.00 


4.00 


3.20 


3.00 


4.50 


2.50 


3.50 


39 


10.00 


10.00 


10.00 


10.00 


10.00 


8.40 


9.00 


8.50 


8.25 


8.50 


40 


8.50 


8.00 


8 . 00 


8.00 


8.00 


7.00 


6.00 


8.00 


7.00 


7.50 


41 


5-00 


4.00 


4.00 


3 . 00 


4.00 


3.20 


3.00 


4.50 


2.00 


4.50 


42 


9.00 


9.00 


9.00 


9.00 


9.00 


7.00 


7.00 


7 . 00 


7.00 


6.50 


43 


5.50 


5.00 


5 . 00 


6.00 


5.00 


5.00 


5.00 


6.00 


5.00 


:': 5.00 


44 


8.00 


8.00 


9.00 


8.00 


8.00 


7.00 


8.00 


8.00 


7.00 


8.00 


45 


8.50 


7.00 


9.00 


8.00 


10.00 


7.00 


7.75 


8.00 


8.00 


7.00 


46 


15.00 


10.00 


13-00 


10.00 


10.00 


10.00 


10.00 


1 1 .00 


10.00 


10.00 


47 


4.80 


5.00 


5.00 


5.00 


5.00 


5.00 


5.00 


5.20 


5.00 


5.00 


48 


25.00 


25.00 


27.00 


25.00 


25.00 


24.00 


24.00 


28.00 


25.00 


25.00 


49 


60.00 


53.60 


60.00 


53.60 


53.60 


60.00 


60.00 


60.00 


55.00 


65.00 


50 



23 



1977 PREVAILING CHARGE SUMMARY DATA 



OCCIDENTAL LIFE INSURANCE CO. 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



CALIFORNIA 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



PSRO-20 


PSRO-21 


PSRO-22 


PSRO-23 


PSRO-24 


PSRO-20 


PSRO-21 


PSRO-22 


PSRO-23 


PSRO-24 




50.00 


61 .25 


60.00 


63.80 


45 . 00 


60.00 


60.00 


- 63.80 


65.00 


63.80 


01 
02 


8.00 


10.00 


8.00 


8.00 


8.00 


7.00 


6.00 


8.00 


7.50 


10.00 


03 


12.00 


12.00 


12.00 


12.00 


10.00 


15.00 


14.00 


16.00 


12.00 


12.00 


04 


20.00 


25.00 


25.00 


20.00 


18.00 


25.00 


24.00 


29.00 


25.00 


20.00 


05 


44.70 


44.70 


44.70 


44.70 


44. 70 


44.70 


40.00 


44. 70 


50.00 


35.00 


06 


60.00 


60.00 


63.80 


60.00 


60.00 


63.80 


63.80 


63.80 


75.00 


67.00 


07 


17.00 


15.00 


15.00 


15.00 


15.00 


19.10 


15.00 


20.00 


19.10 


16.00 


08 


30.00 


35.00 


34.50 


31 .90 


31 .90 


35.00 


33.00 


35.00 


33.00 


38.30 


09 


900.00 


800.00 


900.00 


800 . 00 


900.00 


900.00 


918. 70 


1084.60 


900.00 


850.00 


10 


1110. 10 


1110.10 


1 1 10. 10 


11 10. 10 


1110.10 


1166.80 


1 1 93 • 1 


1283.40 


1176.50 


1200.00 


11 


20.40 


20.00 


20.40 


18.00 


1 5 . 00 


15.00 


20.00 


25.00 


20.00 


19.50 


12 


23. 10 


20.80 


18.50 


20.00 


20.40 


20.00 


25.00 


24.60 


24.60 


20.00 


13 


180.00 


180.00 


180.00 


180.00 


180.00 


180.00 


200.00 


180.00 


180.00 


1 5 . 00 


14 


36.00 


38.30 


50.00 


36.00 


35.00 


60.00 


44.70 


50.00 


39.60 


45.90 


15 


331 .00 


331 .00 


331 .00 


331 .00 


331 .00 


350.00 


350.00 


350.00 


350.00 


350.00 


16 


740. 10 


800.00 


800.00 


740. 10 


800.00 


797.50 


960.00 


960.00 


797.50 


920.00 


17 


16.00 


16.00 


16.00 


16.00 


16.00 


20.00 


20.00 


20.00 


20.00 


20.00 


18 


888.10 


888. 10 


960.00 


900.00 


888. 10 


1000.00 


1000.00 


1200.00 


1000.00 


1000.00 


19 


408.30 


408. 30 


475.00 


427.00 


456.00 


475.00 


459.40 


500.00 


475.00 


500.00 


20 


32.40 


32.40 


35.00 


30.60 


27.55 


35.40 


35-00 


40.00 


39.30 


35.40 


21 


385.00 


360.00 


364.50 


400 . 00 


357.30 


400.00 


382.80 


400.00 


385.00 


400.00 


22 


660.00 


765.60 


750.00 


701 .80 


765.60 


797.50 


760.00 


861 .30 


765.60 


798.00 


23 


450.00 


450.00 


450.00 


459.40 


405.00 


495.00 


500.00 


550.00 


500.00 


480.00 


24 


55.50 


60.00 


55.50 


60.00 


46.30 


60.00 


63.00 


69.50 


60.00 


50.00 


25 


20.00 


16.00 


25.60 


20.00 


24.00 


21 .70 


19.10 


20.00 


19.00 


19. 10 


26 


925. 10 


925. 10 


925. 10 


925. 10 


925. 10 


1000.00 


900.00 


1000.00 


1000.00 


1000.00 


27 


1000.00 


1000.00 


1000.00 


1000.00 


1000.00 


1000.00 


950.00 


1100.00 


1000.00 


1000.00 


28 


810.00 


900.00 


900.00 


900 . 00 


900.00 


975.00 


950.00 


893.20 


900.00 


900.00 


29 


800.00 


800.00 


850.00 


800 . 00 


800.00 


1100.00 


800.00 


1100.00 


900.00 


1000.00 


30 


18.00 


18.00 


17.00 


18.00 


17.00 


17.50 


16.50 


16.00 


21.00 


18.50 


31 


35.00 


30.00 


34 . 50 


30.00 


28.00 


32.50 


36.00 


39.00 


41.50 


39.00 


32 


30.60 


32.00 


25.50 


30.00 


30.00 


28.00 


35.00 


26.25 


30.00 


32.00 


33 


46.00 


63.80 


60 . 00 


60.00 


60.80 


59.00 


59.00 


65.00 


58.00 


68.30 


34 


48.00 


55.00 


62.00 


50.00 


55 . 00 


50.00 


56.00 


55.00 


55.00 


55.00 


35 


27.00 


27.00 


27.00 


27.00 


27.00 


28.00 


28.00 


28.00 


28.00 


28.00 


36 


35.00 


35.00 


35.00 


35.00 


35.00 


35.00 


35.00 


35.00 


35.00 


35.00 


37 


5.00 


5.00 


5.00 


4.00 


5.oO 


6.00 


4.00 


4.00 


3.00 


4.00 


38 


4.00 


3.50 


5.00 


4.00 


5.00 


5.00 


5.00 


4.00 


4.00 


3.00 


39 


9.00 


9.50 


11 .00 


9.00 


9.60 


8.50 


8.00 


9.50 


10.00 


8.00 


40 


8.00 


9.00 


8.50 


9.00 


11.00 


8.00 


7.50 


8 . 00 


7.50 


7.50 


41 


3.50 


4.00 


4.00 


5.00 


4.00 


3.00 


3.75 


4.00 


4.00 


4.00 


42 


9.00 


9.00 


9.00 


10.00 


10.00 


7.00 


7.00 


7.00 


7.00 


6.00 


43 


6.00 


5.00 


6.00 


5.00 


5.00 


5.00 


5.50 


6 . 00 


5.00 


5.00 


44 


8.00 


8.00 


10. 00 


8.00 


8.00 


8.00 


8-00 


8 . 00 


8.00 


;: ; 8.00 


45 


8.00 


9.00 


9.00 


9.00 


8.00 


7.50 


8.50 


9.00 


8.00 


7.50 


46 


12.00 


10.00 


13.00 


15.00 


15.00 


10.00 


10.00 


10.00 


13.00 


12.00 


47 


5.00 


5.00 


6.00 


5.00 


4.80 


5.00 


5.00 


6.00 


5.00 


4.00 


48 


25.00 


27.00 


26.80 


25.00 


25.00 


25.00 


25.00 


25.00 


25.00 


25.00 


49 


53.60 


53.60 


53.60 


73.20 


53.60 


55.00 


55.00 


70.00 


70.00 


55.00 


50 



2k 



1977 PREVAILING CHARGE SUMMARY DATA OCCIDENTAL LIFE INSURANCE CO . 



PROCEDURE DESCRIPTION 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 
PSRO-25 PSRO-26 PSRO-27 PsRO-28 



CALIFORNIA 
LOCALITY DESIGNATION FOR SPECIALIST 
PSRO-25 PSRO-26 PSRO-27 PSRO-28 



01 INITIAL LIM 

02 INITIAL COM 

03 MINIMAL OFF 

04 ROUTINE BR I 

05 ROUTINE BRI 
06 



INITIAL BRI 

07 INITIAL COM 

08 ROUTINE BRI 

09 BIOPSY SKIN 

10 RADICAL MAS 

11 REDUCTION 

12 ARTHOTMY 

13 NEEDLE PUNC 

14 BRONCHOSCOP 

15 THORACENTES 

16 CATHETERIZA 

17 INSERTION 

18 BLOOD TRANF 

19 COLECTOMY 

20 APPENDECTOM 

21 SIGMOIDOSCO 

22 HEMORRHOIDE 

23 CHOLECYSTEC 

24 REPAIR HERN 

25 CYSTOSCOPY 

26 DILATION OF 

27 PROSTATECTO 

28 ELECTROSECT 

29 HYSTERECTOM 

30 EXTRACTION 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMA 

35 X-RAY COLON 
3c CC3ALT 

37 RADIOTHERAP 

38 HEMOGLOBIN 

39 WHITE CELL 

40 COMPLETE BL 

41 CHOLESTERAL 

42 HEMATOCRI 

43 PROTHROMBIN 

44 SEDIMENTATI 

45 BLOOD SUGAR 

46 BUN UREA NI 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARD 

50 ELECTROENCE 



ITED OFFICE VISIT 
P OFFICE VISIT 
ICE VISIT 
EF OFFICE VISIT 
EF HOME VISIT 
EF HOSPITAL VISIT 
P HOSPITAL VISIT 
EF HOSPITAL VISIT 

TECTOMY 

F FRACTURE 

TURE OF BURSA 

Y 

IS 

TION 

F PACEMAKER 

USION 

Y 

PY 

CTOMY 
TOMY 
IA 

URETHRA 
MY 

ION OF PROSTATE 
Y 
OF LENS 



CH 



COUNT 
OOD COUNT 
BLOOD COUNT 



ON RATE 

TRATE 



IOGRAM 
PHALOGRAM 



52 . 00 
12.80 
12.50 
25.00 
35.00 
67.00 
15.00 
30.00 
900.00 
1200.00 
20.40 
25.90 
180.00 
38.00 
331 .00 
740.00 
16.00 
960.00 
475.00 
25.00 
364.50 
750.00 
550.00 
55.50 
25.60 
925. 10 
1000.00 
900.00 
850.00 
20.00 
31.00 
30.00 
63.00 
58.00 
27. CO 
35.00 
4.00 
5.00 
9.50 
8.50 
5.00 
9.00 
6.00 
8.00 
8.50 
16.00 
5.00 
25.00 
60.00 



60.00 
9.00 
12.00 
25.50 
44.70 
63.80 
16.00 
30.00 
800.00 
1110. 10 
20.00 
20.00 
180.00 
50.00 
350.00 
800.00 
16.00 
999. 10 
427.50 
30.00 
357.30 
700 . 00 
450.00 
60.00 
25.00 
1000.00 
893.20 
840.00 
800.00 
18.50 
31.90 
31 .90 
62.50 
: 57.40 
27.00 
35.00 
4.50 
4.00 
10.00 



00 
00 



9.00 

7.00 

8.00 

8.00 

10.00 

5.00 

25.00 

53.60 



52.00 
9. 60 
10.20 
18-00 
31 .90 
60.00 
12.00 
24.00 
800.00 
1 11 . 00 
16.00 
18.00 
180.00 
32.50 
331 .00 
750.00 
16.00 
888. 10 
400.00 
25-00 
357.30 
600.00 
360.00 
55.50 
25.60 
925. 10 
1000.00 
900.00 
800.00 
17-90 
31-90 
30-00 
63-00 
58.00 
27.00 
35.00 
4.00 
4.50 
8.00 
7.50 
4-00 
9-00 
5.00 
7 . 50 
7.00 
10.00 
4.00 
25.00 
53.60 



60.00 
8.00 
1 1 . 00 
20.00 
34.50 
60.00 
12.80 
30.00 
800.00 
1110. 10 
20.00 
18.50 
180.00 
32.50 
350.00 
800.00 
16.00 
888. 10 
408.30 
30.00 
350.00 
693 . 00 
448 . 00 
55.50 
24.00 
925.10 
1000.00 
900 . 00 
800 . 00 
18.00 
27.00 
31 -90 
55.00 
60 . 00 
27.00 
35.00 
4.00 
3.50 
1 . 00 
:: 9.00 



20 

00 
00 



8.00 

9.00 

12.50 

5.00 

25.00 

53.60 



63.80 
10.00 
15.00 
25.00 
50.00 
65. 10 
20.00 
35.00 
1250.00 
1340.80 
16.00 
25.00 
180.00 
40.00 
300.00 
707.50 
20.00 
1200.00 
500.00 
35.00 
450.00 
900.00 
600.00 
66.00 
18.00 
1100.00 
1100.00 
957.00 
1000.00 
20.00 
30.00 
30.50 
64.40 
55.00 
28.00 
35.00 
3.5o 
4.00 
10.00 
8.00 
4.00 
6.50 
6.00 
8.00 
8.00 
10.50 
5.00 
25.00 
70.00 



63.80 
7.00 
15.00 
29.00 
40.00 
75.00 
19. 10 
33.00 
1000.00 
1176.50 
15.00 
24.60 
175.00 
44.70 
350.00 
960.00 
20.00 
970.00 
459.40 
32.40 
382.80 
740.10 
459.40 
59.60 
20.00 
1000.00 
995.30 
893.20 
850.00 
17.00 
44.70 
30.00 
60.00 
55.00 
28.00 
35.00 
3.75 
5.00 
9.00 
8.00 
4.00 
10.00 
5.50 
7.50 
7.50 
9.50 
5.50 
25.00 
63.80 



63.80 
5.00 
10.00 
25.00 
35.00 
63.80 
12.00 
35.00 
770.00 
1097.20 
15.00 
23.60 
1 60.80 
32.00 
350.00 
797.50 
20.00 
900.00 
459.40 
34.50 
350.00 
720.00 
433.80 
50.00 
24.00 
900.00 
893.20 
850.00 
800.00 
16.00 
30.00 
28. 10 
55.00 
46.00 
28.00 
35.00 
4.00 
3.00 
7.50 
7.00 
3.60 
7.00 
6.00 
6.00 
7.00 
9.00 
4.50 
24.00 
50.00 



61.00 
8.00 
11 .00 
20.00 
31 .90 
65.00 
12.00 
32.00 
900.00 
1100.00 
20.00 
22. 10 
172.00 
36.00 
350.00 
960.00 
20.00 
900.00 
448.50 
30.00 
344.50 
725.00 
450.00 
54.60 
18.00 
900.00 
900.00 
775.00 
840.00 
17.00 
28.00 
28.00 
60.00 
57.40 
28.00 
35.00 
3.00 
3.20 
8.50 
7.00 
3.50 



00 
75 
00 
00 



10.00 

5.00 

25.00 

60.00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
I 15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



25 



COLORADO 




One Locality - Statewide 



26 



1977 PREVAILING CHARGE SUMMARY DATA 



COLORADO MEDICAL SERVICE 



COLORADO 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 
SINGLE 

10-00 

42.00 
6.00 
8.00 

15.00 

30.00 

42.00 

10.00 

20.00 
480.00 
704.00 

1 5 . 00 

1 5 . 00 
150.00 

25.00 
180.00 
550.00 
5.00 
540.00 
270.00 

20.00 
210.00 
465.00 
255.00 

56.00 

15.00 
552.00 
552.00 
580.00 
550.00 

15.00 

30.00 

19.50 

1 5 . 00 

-::■ 36.00 

15.00 
15.00 

3.00 

3.00 

7 . 50 

8.40 

3.25 

5.00 

4 . 00 

8.00 

8.40 

8.00 

4.00 
19.00 
16.50 



LOCALITY DESIGNATION FOR SPECIALIST 
SINGLE 



15 


.00 


50 


.00 


6 


.00 


10 


.00 


15 


.00 


35 


.00 


52 


.50 


10 


.00 


20 


.00 


589 


.00 


704 


.00 


19 


.20 


20 


.00 


125 


.00 


30 


.10 


150 


.00 


500 


.00 


7 


00 


600 


00 


300 


00 


21 


00 


245 


00 


530 


00 


265 


00 


48 


00 


12 


00 


600 


00 


600 


00 


600 


00 


550 


00 


10 


00 


25 


50 


20. 


00 


12 


00 


36. 


00 


30. 


00 


30. 


00 


2. 


50 


3. 


00 


7. 


oo 


8. 


00 


3. 


00 


5. 


00 


4. 


00 


8. 


00 


8. 


00 


6. 


00 


4. 


00 


20. 


00 


40. 


00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 






' 7 



• 


















: 



" 



27 






CONNECTICUT 




Four Localities: 

01 - Northwest and North Central 

02 - Southwest 

03 - South Central 
0U - Northeast and Southeast 

(For more, locality information see Appendix A) 



28 



1977 PREVAILING CHARGE SUMMARY DATA 



CONNECTICUT GENERAL LIFE INS. 



CONNECTICUT 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISJT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



II 



III 



IV 



LOCALITY DESIGNATION FOR SPECIALIST 
I II III IV 



19.20 


19.20 


1 5 . 00 


15.00 


19.20 


20.00 


25.00 


19.20 


30.00 


35.00 


25.00 


25.50 


35.00 


38.30 


35.00 


31.90 


5.00 


6.00 


6.00 


5.00 


6.40 


6.40 


6.40 


5.00 


1 1 .50 


11 .80 


12.00 


1 . 00 


12.80 


15.00 


12.80 


12.00 


15.00 


19.20 


1 5 . 00 


1 5 . 30 


17.00 


25.00 


19.20 


15.30 


25.00 


25.00 


25.00 


25 .00 


25.00 


36.00 


25.00 


25.00 


31 .90 


31 .90 


35.00 


30.00 


45.60 


44.70 


44.70 


31 .90 


12.80 


12.80 


12.80 


12.80 


12.80 


19.20 


12.80 


12.80 


25.00 


30.00 


25.00 


30.00 


30.00 


40.00 


25.00 


25.00 


640.00 


640.00 


640.00 


640.00 


560.00 


893.50 


720.00 


630.00 


700.00 


700.00 


700.00 


700 . 00 


660.00 


750.00 


750.00 


638.20 


17.00 


15.00 


19.20 


17.00 


1 7 . Oo 


15.00 


17.00 


19.20 


17.00 


15.00 


19.20 


17.00 


17.00 


19.20 


15.00 


19.20 


165.00 


165.00 


165.00 


165.00 


159.60 


191 . 50 


190.00 


175.00 


25.00 


25.00 


25.00 


25.50 


38.30 


50.00 


40.00 


25.00 


350.00 


350.00 


350.00 


350.00 


200.00 


250.00 


250.00 


250.00 


850.00 


850.00 


850.00 


850.00 


765.80 


850.00 


850.00 


850.00 


25.00 


25.00 


25.00 


25.00 


20.00 


22.00 


20.00 


17.90 


735.00 


735.00 


735.00 


735.00 


690.00 


900.00 


750.00 


635.00 


400.00 


400.00 


400.00 


400.00 


350.00 


400.00 


400.00 


300.00 


20.00 


28.00 


20.00 


25.00 


25.00 


25.00 


25.00 


25.00 


300.00 


300.00 


300.00 


300 . 00 


275.00 


325.00 


293.60 


220.00 


550.00 


550.00 


550.00 


550.00 


480.00 


600.00 


574.60 


475.00 


280.00 


280.00 


280.00 


280.00 


300.00 


446.70 


360.00 


275.00 


60.00 


60.00 


60.00 


60.00 


.;■*:::■:•::• g Q Q Q 


63.80 


60.00 


51 . 10 


20.00 


20.00 


20.00 


20.00 


15.00 


19.20 


19.20 


25.00 


750.00 


750.00 


750.00 


750.00 


600.00 


850.00 


750.00 


550.00 


660.00 


660.00 


660.00 


660.00 


250.00 


750.00 


638.20 


638.20 


650.00 


650.00 


650.00 


650.00 


575.00 


750.00 


638.20 


500.00 


700.00 


700.00 


700.00 


700 .00 


638.20 


850.00 


638.20 


600.00 


22.00 


25.00 


22.00 


20 . 00 


24.00 


25-00 


22.00 


20.00 


28.00 


35 . 00 


38-30 


39.00 


36.00 


39.60 


38.30 


33.00 


30.00 


30.00 


30.00 


30 . 00 


20.00 


30.00 


35.00 


30.00 


55.90 


60.00 


60.00 


60 . 00 


: 57.40 


67.70 


55.00 


50.00 


60.00 


60.00 


60.00 


60. 00 :: 57.40 


63.80 


57.40 


50.00 


20.00 


20.00 


20.00 


20.00 


15.00 


20.00 


19.20 


20.00 


15.84 


15.64 


15.84 


15.84 


15.00 


11 .00 


15.84 


15.84 


3.00 


2.00 


6.00 


2.00 


2.25 


3.00 


5.00 


3.00 


2.00 


2.50 


3.00 


2.00 


2.50 


5.00 


5.00 


5.00 


6.00 


11 .00 


9.00 


8.40 


7.00 


9.00 


8.00 


8 . 40 


6.50 


7 . 00 


7.00 


6 . 00 


6. 00 


6.00 


6.00 


6.00 


3.00 


2.50 


3 . 00 


2.50 


3.00 


4.00 


3.00 


2.50 


5.00 


5.00 


5.00 


5.00 


5.00 


5.00 


5.00 


5.50 


:. 3 . oo 


5.00 


5.00 


: 3.50 


3 . 50 


5.00 


5.00 


3.00 


: 5.50 


5.00 


6.00 


■ : ' 5 sO *5 On 


5.00 


5.00 


5.00 


6.00 


6.00 


6.00 


6.00 


6.00 


6.00 


6.00 


6.00 


5.00 


7.00 


5.00 


5.00 


6.50 


8.00 


6.00 


10.00 


3.60 


5.00 


4.00 


3.50 


3.00 


5.00 


5.00 


3.60 


19.20 


20.00 


20.00 


20.00 


19.20 


22.00 


19.20 


19.20 


51 .30 


51 .30 


51.30 


51 .30 


55.10 


50.00 


45.00 


50.00 



01 

02 

03 

04 

OS 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



29 



DELAWARE 







One Locality - Statewide 



30 



1977 PREVAILING CHARGE SUMMARY DATA B/C-B/S OF DELAWARE 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



PROCEDURE DESCRIPTION 



SINGLE 



DELAWARE 
LOCALITY DESIGNATION FOR SPECIALIST 



SINGLE 



INITIAL 
INITIAL 

MINIMAL 
ROUTINE 
ROUTINE 
INITIAL 
INITIAL 
ROUTINE 
BIOPSY 



LIMITED OFFICE VISIT 
COMP OFFICE VISIT 
OFFICE VISIT 
BRIEF OFFICE VISIT 

HOME VISIT 

HOSPITAL VISIT 

HOSPITAL 

HOSPITAL 



BRIEF 
BRIEF 
COMP 
BRI EF 
SKIN 



VISIT 
VISIT 



RADICAL MASTECTOMY 

REDUCTION OF FRACTURE. 

ARTHOTMY 

NEEDLE PUNCTURE OF BURSA 

BRONCHOSCOPY 

THORACENTESIS 

CATHETERIZATION 

INSERTION OF PACEMAKER 

BLOOD T RAN FUSION 

COLECTOMY 

APPENDECTOMY 

SIGMOIDOSCOPY 

HEMORRHOIDECTOMY 

CHOLECYSTECTOMY 

REPAIR HERNIA 

CYSTOSCOPY 

DILATION OF URETHRA 

PROSTATECTOMY 

ELECTROSECTION OF PROSTATE 

HYSTERECTOMY 

EXTRACTION OF LENS 

X-RAY CHEST 

X-RAY SPINE 

X-RAY HIP 

X-RAY STOMACH 

X-RAY COLON 

COBALT 

RADIOTHERAPY 

HEMOGLOBIN 

WHITE CELL COUNT 

COMPLETE BLOOD COUNT 

CHOLESTERAL BLOOD COUNT 

HEMATOCRIT 

PROTHROMBIN 

SEDIMENTATION RATE 

BLOOD SUGAR 

BUN UREA NITRATE 

PAP TEST 

URINALYSIS 

ELECTROCARDIOGRAM 

ELECTROENCEPHALOGRAM 






30 

30 

8 

10 

12 

25 

30 

8 

26 

573 

555 

19 

18 

123 

26 

132 

250 

17 

776 

317 

20 

220 

476 

317 

52 

10 

564 

546 

639 

538 

15 

25 

19 



.00 
.00 

90 
.00 
.00 
.00 
.00 

90 
.46* 
.30* 
.66* 
.10 

• 40 
.48* 

46* 
.30* 
.00 

• 64* 
. 16* 

■ 52* 
.00 
.50* 
.28* 
.52* 
.92* 
.20 
.48* 
.84* 

■ 45* 
.02* 
.00 
.00 
.00 



53.00 
14.00 
14.00 



60 
60 
50 
10 



2.00 
6.00 
5.00 
5.00 
5.00 
6.40 
3.00 
20.00 
52.30 



40.00 


01 


. 40.00 


02 


12.00 


03 


15.00 


04 


15.00 


05 


31 .90 


06 


44.70 


07 


12.80 


08 


19.10 


09 


765.80 


10 


696.78* 


11 


31 .90 


12 


21 .86* 


13 


136.90 


14 


50.00 


15 


142.05* 


16 


250.00* 


17 


21 .86* 


18 


961 .84* 


19 


287.20 


20 


31 .90 


21 


255.30 


22 


446.70 


23 


287.20 


24 


63.80 


25 


18.00 


26 


590.00 


27 


580.00 


28 


657.00 


29 


574.40 


30 


17.00 


31 


25.00 


32 


25.00 


33 


90.00 


34 


53.00 


35 


14.00 


36 


14.00 


37 


2.60 


38 


2.50 


39 


8.50 


40 


6.00 


41 


3.00 


42 


6.00 


43 


5.00 


44 


5.00 


45 


5.00 


46 


6.00 


47 


3.00 


48 


20.00 


49 


52.30 


50 



31 



DISTRICT OF COLUMBIA 



One Locality: 




Washington Metropolitan Area, includes Washington, D»C; 
Prince Georges and Montgomery Counties in Maryland; 
Fairfax and Arlington Counties in Virginia and the city 
of Alexandria, Virginia 



32 



1977 PREVAILING CHARGE SUMMARY DATA MEDICAL SERVICE OF D. C. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBiLT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



SINGLE 



WASHINGTON D.C. 
LOCALITY DESIGNATION FOR SPECIALIST 

SINGLE 



39 

40 

14 

12 

16 

38 

50 

12 

25 

638 

686 

20 

19 

159 

50 

588 

980 

19 

800 

300 

20 

300 

523 

300 

SO. 

19. 

675. 

800. 

833. 

669. 

15. 

25. 

23. 

50. 

45. 

24. 

15. 

5. 

4. 

7. 

6. 

3. 

7. 

5. 

6. 

6. 

7. 

3. 

20. 

50. 



• 60 
.00 
.00 
.00 
.50 

• 30 

• 00 
.80 
.00 
.00 
.00* 
-00 
. 10 

• 50 

■ 00 
.00* 
.00* 

■ 60* 
00 

.00 
.00 

■ 00 
20 

• 00 
.00 
. 10 
.00 
.00 
.00* 

• 90 
.00 
.00 
.00 
.00 
.00 
.00* 
.00 
.00 
.00 

70 
00 
50 
00 
00 
00 
00 
70 
80 
25 
00 



' . . v:..- 






44 


.70 


51 


.00 


17 


.00 


12 


.80 


20 


.00 


44 


.70 


63 


.80 


1 5 


.00 


35 


.70 


638 


.00 


640 


.00 


25 


.00 


32 


. 10* 


159 


.50 


53 


.50* 


950 


.00 


1350 


00* 


21 


40* 


910 


00 


319 


OO 


31 


90 


395 


90* 


523 


20 


350 


00 


80 


00 


19 


10 


765 


60 


750 


00 


638 


00 


669 


90 


15 


00 


33 


00 


24 


00 


57 


40 


55 


00 


37 


00 


12. 


50 


5 


00 


6. 


00 


7. 


50 


6. 


00 


3. 


80 


6. 


00 


3. 


80 


5. 


50 


5. 


50 


7. 


50 


3. 


80 


22. 


00 


45. 


00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



33 




Four Localities: 

A -Baker, Bay, Bradford, Calhoun, Columbia, Desota, 
Dixie, Flagler, Franklin, Gadsden, Gilchrist, 
Glades, Gulf, Hamilton, Hernando, Highlands, 
Holjues, Jackson, Jefferson, LaFayette, Lake, 
Levy, Liberty, Madison, Marion, Nassau, Ckaloosa, 
Osceola, Pasco, Putnam, St. Johns, Seminole, 
Sumter, Suwannee, Taylor, Wakulla, Walton, 
Washington, Citrus 

B -Alachua, Brevard, Charlotte, Clay, Duval, Escambia, 
Hardee, Hendry, Hillsborough, Indian River, Lee, 
Leon, Manatee, Martin, Okeechobee, Orange, 
Pinellas, Polk, St. Lucie, Santa Rosa, Sarasota, 
Union, Volusia 

C - Broward, Collier, Palm Beach 

D - Dade , Monroe 

Florida Blue Shield - A,B,C 
Group Health Incorporated - D 



Group Health Incorporated' 



4r" 



3^ 



1977 PREVAILING CHARGE SUMMARY DATA 



B/S OF FLORIDA 



FLORIDA 



COMBINED LOCALITY DESIGNATION 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN - 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 









AREA A 

30 . 00 

30.00 

5.00 

10.00 

15.00 

35.00 

35.00 

14.00 

25. 10 

750.00 

765. 60 

15.00 

1 5 . 00 

160.00 

35.00 

250.00 

701 .80 

638.00 

350.00 

25.10 

265.50 

5 1 . 40 

294.80 

35.00 

15.00 

638.00 

638.00 

659.70 

600.00 

18.00 

53.90 

25.50 

45.00 

45.00 

34.60 

25.50 

3.80 

3.00 

8.00 

6.00 

3.00 

5.00 

5.00 

6.00 

6.40 

8.00 

4.00 

20.00 

50.00 



AREA B 


AREA C 




38.30 


35.00 


01 


38.30 


35.00 


02 


6.00 


7.00 


03 


12.00 


12.80 


04 


19. 10 


25.00 


05 


44.70 


50.00 


06 


44.70 


50.00 


07 


15.00 


20.00 


08 


25.00 


27.80 


09 


750.00 


835.80 


TO 


765.60 


957.00 


11 


18.00 


18.00 


12 


16.20 


16.00 


13 


155.00 


159.50 


14 


35.00 


50.00 


15 


250.00 


250.00 


16 


765.60 


780.00 


17 
18 


701 .80 


850.00 


19 


350.00 


404.00 


20 


26.00 


3 1 . 90 


21 


270.00 


297.00 


22 


548.70 


638.00 


23 


350.00 


400.00 


24 


44.70 


55.00 


25 


15.00 


20.00 


26 


701 .80 


800.90 


27 


638.00 


861 .30 


28 


650.00 


731 .30 


29 


638.00 


701 .80 


30 


19.00 


22.00 


31 


57.70 


67.00 


32 


25.50 


25.50 


33 


54.00 


60.00 


34 


45.90 


57.40 


35 


35.00 


35.00 


36 


25.50 


29.30 


37 


3.80 


5.00 


38 


3.80 


4.00 


39 


8.00 


10.00 


40 


6.00 


8.00 


41 


3.50 


3.80 


42 


5 . 00 


6.40 


43 


5.00 : 


5.00 


44 


6.00 


6.40 


45 


6.40 


7.00 


46 


7.00 


10.00 


47 


4.00 


5.00 


48 


19.10 


25.00 


49 


50.00 


50.00 


50 



35 



1977 PREVAILING CHARGE SUMMARY DATA 



GROUP HEALTH INCORPORATED 



FLORIDA 



COMBINED LOCALITY DESIGNATION 



PROCEDURE DESCRIPTION 



SINGLE 



01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



".-'...■' : 



■: :-:-.■■-:-:■:■:-:-:■:•:■:■ •:•:■■■■:■•>:■ 



: . . : : : : : : : : : : :-. : : ; :o 





38.30 




- 38.30 




15.00 




15.00 




25.00 




50.00 




50.00 




25.00 




25.00 




862.00 




1006.30 




15.00 




20.00 




150.00 




50.00 




300.00 




1000.00 




25.00 




1000.00 




4 1 6 . 90 




31 .90 




400.00 




765.60 




412.75 




50.00 




20.00 




826.60 




861 .30 




754.80 


:sSg;:s»;>:;;;:«ftg; 


701.80 




20.00 




38.30 




25.50 




57.40 




57.40 




20.00 




20.00 




16.00 




5.00 




9 . 00 




6.00 




5.00 




7.00 




7.00 




6.00 




6.00 




10.00 




5.00 




25.00 




65.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 






36 






GEORGIA 






37 



GEORGIA 




SAVANNAH 



Four Localities (by counties) 
(For more locality information 
see Appendix A) 



38 



1977 PREVAILING CHARGE SUMMARY DATA PRUDENTIAL INSURANCE COMPANY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 C03ALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



01 



02 



03 



04 



GEORGIA 
LOCALITY DESIGNATION FOR SPECIALIST 
01 02 03 04 



15.00 


15.00 


15.00 


12.00 


50.00 


57.40 


38.30 


25.00 


8 . 90 


8.90 


8.90 


6.40 


13.80 


13.00 


1 5 . 00 


12.00 


35.00 


31 .90 


31 .90 


25.00 


51 .00 


51 .00 


44.70 


35.00 


11 .40 


12.00 


10.00 


12.00 


15.00 


15.00 


15.00 


15.00 


600.00 


600 . 00 


600.00 


600 . 00 


500.00 


500.00 


500.00 


500 . 00 


15.00 


15.00 


10.00 


10.00 


15.00 


10.00 


8.00 


10.00 


153.10 


153. 10 


153.10 


153. 10 


25.00 


25.00 


25.00 


25.00 


235.80 


235.80 


235.80 


235.80 


697.70 


697.70 


697.70 


697.70 


16.00 


16.00 


16.00 


16.00 


612.50 


612 .50 


612.50 


612.50 


285.00 


285.00 


285.00 


285.00 


25.00 


15.30 


19.10 


20.00 


275.00 


275.00 


275.00 


275.00 


446.60 


446.60 


446.60 


360 . 00 


255.20 


255.20 


255.20 


300 . 00 


40.00 


40.00 


40.00 


40.00 


19.10 


19.10 


19.10 


20.00 


574.20 


574.20 


574.20 


574.20 


620.00 


620.00 


620.00 


620.00 


550.00 


550.00 


550.00 


550.00 


550.00 


550.00 


550.00 


550.00 


8.00 


8.00 


8.00 


8.00 


16.00 


16.00 


1 6 . 00 


16.00 


12.00 


12.00 


12.00 


12.00 


24.00 


24.00 


24.00 


24.00 


22.50 


22.50 


22.50 


22.50 


: S . 75 


19 . 75 


19.75 


19.75 


14.75 


14.75 


14.75 


14.75 


3.00 


3.80 


2.60 


3.00 


4.00 


3.80 


3.50 


2.60 


8-00 


7.70 


7.00 


7.70 


6.00 


6 . 00 


6.00 


6 . 00 


3.00 


3.00 


2.60 


2.60 


6.00 


6 . 00 


5.00 


6.0O 


6.00 


6-00 


5.00 


5.00 


6.00 


6 . 00 


6.00 


6.00 


5.00 


6.00 


6.40 


6.00 


7.70 


6.00 


7.70 


7.70 


4.90 


3.80 


3.00 


1 .90 


16.00 


19.10 


18.00 


19.10 


45.00 


45.00 


45.00 


45.00 



25.00 


15-00 


15.00 


25.00 


75. OO 


44.70 


50.00 


50.00 


12.80 


12.00 


10.00 


8-90 


19.10 


15.00 


17.90 


12.80 


50.00 


44. 70 


35.00 


31 .90 


75.00 


57.40 


50.00 


40.00 


12.80 


12.00 


12.80 


12.30 


25.00 


20.00 


20.00 


24.00 


650.00 


540.00 


525.00 


600.00 


714.60 


714.60 


638.00 


638.00 


15.00 


15.00 


16.00 


10.00 


15.00 


15.30 


8.00 


8.00 


243.40 


150.00 


120.00 


1 12.00 


35.00 


30.00 


35.00 


35.00 


255.20 


210.00 


238.60 


235.80 


697.70 


697.70 


697.70 


638.00 


15.00 


16.00 


16.00 


16.00 


750.00 


612.50 


510.40 


612.50 


280.00 


280.00 


285.00 


280.00 


30.00 


25.00 


25.00 


20.00 


245.00 


245.00 


275.00 


245.00 


5 1 . 40 


459.40 


400.00 


478.50 


344.50 


287. 10 


297.00 


300.00 


40.00 


38.30 


40.00 


60.00 


12.00 


12.80 


10.00 


12.00 


574.20 


574.20 


510.40 


574.20 


6 1 2 . 50 


650.00 


562.00 


500.00 


550.00 


500.00 


550.00 


550.00 


561 .40 


543.20 


500.00 


500.00 


8.00 


12.00 


7.50 


8.00 


14.00 


17.60 


15.00 


9.50 


8.00 


12.00 


11.00 


9.00 


22.00 


26.00 


23.00 


19.10 


18.00 


24.20 


22.00 


19. 10 


28.50 


30.00 


15.00 


30.00 


3.00 


3.80 


3.00 


2.60 


4.00 


3.00 


2.60 


3.00 


6.40 


8.30 


7.50 


8.00 


6.00 


7.00 


5.50 


6.00 


3.00 


3.00 


3.00 


2.00 


7.70 


: 6.00 


5.00 


5.00 


3.00 


4.00 


4.00 


3.00 


6.40 


7.00 


6.00 


6.00 


6.40 


7.00 


6.00 


8.00 


8.50 


7.00 


7.00 


7.50 


3.80 


3.80 


3.80 


3.80 


19.10 


19. 10 


19.10 


19.10 


50.00 


45.00 


50.00 


50.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



39 



GUAM 




One Locality: 

99 - Guam - all Part 3 Claims processed 
by Aetna-Hawaii 



COCO! iSi»".£> 



Uo 



HAWAII 



kl 



HAWAII 



(p.. 





OH 

HONOLULU 







*£> 



*t»OOi.A»t 



Four Localities: 

01 - Honoltilu County 

02 - Hawaii County 

03 - Kauai County 

Ok - Maui County and Kalawao County 




k2 



1977 PREVAILING CHARGE SUMMARY DATA AETNA LIFE AND CASUALTY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



HAWAII 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 



01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETF"!ZA T ION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 
X-RAY CHEST 
X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



31 
32 



01 

1 5 . 00 
44.70 

8.00 

8.90 

19.10 

25.00 

53.60 

9.60 

25.50 

816.00 

787.50 

26.80 

25.50 

153.10 

26.80 

345.80 

893.20 

40.80 

816.60 

357.30 

26.80 

287. 10 

574.20 

319.00 

71.50 

26.50 

714.60 

717.80 

714.60 

765.60 

15.30 

31 .30 

27.25 

48.20 

51 

23 

35.20* 

4.20 

4.20 

8.30 

7.20 

4.40 

6.25 

5.75 

8.30 

7.30 

7.25 

3.10 

23.00 

58.10 



00 
00 



11 . 

44. 
6. 
7. 

12. 
23. 
46. 
7. 
25. 
816. 
787. 
18. 
21 - 
153. 
28. 
345. 
893. 
40. 
816. 
357. 
23. 
287. 
574. 
319. 
71 - 
26. 
714. 
717. 
714. 
765. 
14. 
31 . 
25. 
47. 
51 • 
23 
28. 
6 
4 
7 
6 
3 
6 
4 
6 
6 
5 
3 
19 
58 



02 

50 

70 

10 

70 

80 

00 

50 

70 

50 

60 

50 

00 
,80 
. 10 
.10 
.80 
.20 
.80 
.60 
.30 
.00 
. 10 
-20 
.00 
.50 
.50 
.60 
.80 
.60 
.60 
.30 
.30 
.75 
.80 
.00 

00 
.40* 
.00 
.20 
.30 
.90 
. 10 
.25 
.70 
.25 
.25 
.50 
. 10 
. 10 
.10 



1 1 . 
44. 
6. 
7. 
19. 
23. 
51 . 
7. 
24. 
816. 
787. 
18. 
21 . 
153. 
28. 
345. 
893. 
40. 
816. 
357. 
26. 
287. 
574. 
319. 
71 . 
26. 
714. 
717. 
714. 
765. 
15. 
31 
27 
47 
51 
23 
26 
5 
4 
8 
8 
3 
6 
5 
10 
7 
7 
3 
19 
58 



03 

50 

70 

00 

70 

10 

00 

00 

70 

00 

60 

50 

90 
.80 

10 
. 10 

80 
.20 

80 
.60 

• 30 

• 80 
.10 
.20 
-00 
.50 

■ 50 
.60 
.80 
.60 
.60 

• 30 
.30 

• 25 
.80 
.00 
.00 
.40* 
.00 

• 20 
.00 
.00 
.60 
.25 
-20 
.00 

■ 30 
.30 
.40 

• 90 
.10 



04 

11 . 50 

44.70 

5.20 

8.30 

11 .70 

21 .80 

47.30 

7.70 

25.00 

816.60 

787.50 

18.20 

15.60 

153. 10 

28. 10 

345.80 

893.20 

40.80 

816.60 

357.30 

26.20 

287. 10 

574.20 

319.00 

71 -50 

26.50 

714.60 

717.80 

714.60 

765.60 

12.00 

31 -30 

27.25 

45.90 

51 .00 

23.00 

29.20* 

4.40 

4.20 

10.30 

8.00 

3.00 

9.40 



20 
40 
30 
80 



4.40 
18.70 
58.10 



99 

12.50 

44.70 

8.00 

6.40 

19.10 

23.00 

51 .00 

7.50 

25.50 

8 1 6 . 60 

787.50 

23.00 

21 .80 

153.10 

28. lO 

345.80 

893.20 

40.80 

816.60 

357.30 

26.80 

287. lO 

574.20 

319.00 

71 .50 

26.50 

714.60 

717.80 

714.60 

765.60 

15.30 

3 1 . 30 

27.25 

47.80 

51 .00 

23.00 

34.80* 

4.20 

4.20 

8.80 

8.00 

3.60 

6-25 

5.20 

8.30 

7.30 

7.30 

3.10 

23.00 

58.10 



01 

15.30 

51 .00 

7.70 

10.20 

18.20 

31 .90 

63.80 

15.30 

33.20 

8 1 6 . 60 

787.50 

30.00 

27.90 

141 .60 

30.60 

345.80 

893.20 

40.80 

816.60 

408 . 20 

30.60 

306.20 

6 1 2 . 50 

357.30 

71 .50 

31 .20 

714.60 

765.60 

714.60 

765.60 

17.20 

30.90 

30.40 

57.40 

52.30 

23.00 

33.20* 

3.60 



40 
10 
00 
00 



8.25 
6.20 



30 
30 
60 
60 



25.50 
58.10 



15. 

51 . 
7. 
9. 
18. 
26. 
63. 
12. 
25. 
816- 
787. 
23. 
18. 
143. 
28. 
345. 
893. 
40. 
624. 
408. 
24. 
229. 
436. 
291 . 
71 . 
31 . 
714. 
717 
714 
765 
12 
22 
25 
38 
52 
23 
33 
5 
4 
8 
8 
5 
7 
7 
7 
7 
10 
4 
23 
58 



02 

.60 
00 
.70 
.60 
.20 
.50 
.80 
.00 
.50 
.60 
.50 
.90 
.90 
.60 
.70 
.80 
.20 
.80 
.00 
.30 
.90 
.70 
.80 
.20 
.50 
.20 
.60 
.80 
.60 
.60 
.80 
.30 
.50 
.30 
.30 
.00 
.20* 
.20 
.70 
.80 
.00 
.20 
.90 
.30 
.80 
.30 
.00 
.00 
.40 
.10 



03 

1 3 . 40 

51.00 

7.70 

8.90 

18.20 

25.20 

53.60 

8.90 

25.50 

816.60 

787.50 

24.00 

26.50 

143.60 

28.70 

345.80 

893.20 

40.80 

714.60 

408.30 

26.80 

306.20 

6 1 2 . 50 

322.20 

71 .50 

31 .20 

714.60 

717.80 

714.60 

663.50 

16.70 

30.90 

30.40 

57.40 

52.30 

23.00 

33.20* 

4.20 

4.70 

8.80 

8.00 

4.20 

8.30 

6.20 



80 
30 
60 
60 



25.50 
58. 10 



04 

13.50 

51 .00 

7.00 

8.90 

18.20 

23.40 

53.60 

8.90 

25.50 

816.60 

787.50 

17.90 

26.00 

143.60 

28.70 

345.80 

893.20 

40.80 

707.20 

408.30 

26.80 

306.20 

612.50 

312.60 

71 .50 

26.20 

669.90 

717.80 

714. 60 

714.60 

12.00 

30.90 

30.40 

57.40 

52.30 

23.00 

33.20* 

4.70 

4.70 

10.30 

6.80 

4.70 

9.40 

6.50 

9.40 

9.40 

9.60 

4.70 

15.60 

58.10 



99 



15.30 

51 .00 

7.70 

7.40 

18.20 

30.60 

44.40 

8.00 

25.50 

8 1 6 . 60 

787.50 

24.00 

26.50 

143.60 

28.70 

345.80 

893.20 

40.80 

8 1 6 . 60 

408.30 

30.60 

306.20 

6 1 2 . 50 

357.30 

71 .50 

31 .20 

714.60 

7 1 7 . 80 

7 1 4 . 60 

510:40 

16.30 

30.70 

30.40 

5 7.40 

52.30 

23.00 

33.20* 

4.20 

4.70 

8.80 

8.00 

4.20 

8.30 

6.20 

7.80 

7.30 

9.00 

3.60 

25.50 

58. 10 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
1 1 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



U3 



IDAHO 




11 - South Idaho 

12 - North Idaho, Idaho and 
Lemhi Counties and points north 



kk 



1977 PREVAILING CHARGE SUMMARY DATA EQUITABLE LIFE ASSURANCE SOCIETY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF FACEKAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NI TRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



11 

12.80 

44.70 

5.10 

7.70 

14.00 

20.00 

40.00 

7.70 

25.50 

446.70 

350.00 

10.00 

12.00 

121 -30 

30.00 



5.00 



12 

12.80 
45.50 



10 
70 



15.30 

24.00 

40.00 

7.70 

20.00 

446.70 

612.70 

12.80 

14.00 

21 .00 



24.90 





285.00 


:■:-■, :*:»:•: :«;/:>..,/' ••■: .■:■*■«.■ 




19.20 


24.30 




200.00 


209.00 




435. CO 


434 . 00 




223.40 


236.10 




44.70 






7.00 


12.80 




510.60 
400.00 




■:o: : . : : : : : : : : ; :-: ; : : : ; :-: ; x ; :v:;; : :;x: 


375.00 
1 5 . 00 


12.60 




28.10 


22. 10 




18.00 


22.00 




45.00 


39.60 




45.00 


30.60 




3.00 


3.00 




4.00 


3.00 


?$%V^:?'--'X:i$&i 


8 . 00 
6.50 


8.40 
7.50 




4.00 


2.50 




5.00 


8 . 50 




5.00 


3.60 




6.00 
6.00 


6 . 00 




5.00 




10.00 


8.00 




3.60 


3.60 




19.20 


19.20 




55.00 





IDAHO 
LOCALITY DESIGNATION 
11 

■..-.-. . ■■:-.■ .■ 

15.00 
45.00 
6.00 
10. 20 
19.20 
25.00 
44. 70 
10.00 
25.00 

■::<<fVimm^-:, 446 . 70 

612.70 

11 .00 

13.80 
121.30 

30.00 
177. 10 
510.60 

17. 70 
630.00 
294.50 

19.20 
221 .40 
446.70 
255.30 

36.00 

12.00 
620.00 
510.60 
510. 60 
478.70 

20.00 

25.00 

18.80 

44.00 

44.00 

10.00 

2.40 
2.30 
8.00 
6.60 



50 
00 
00 
00 



8.00 

6.00 

4.00 

20.00 

55.00 



FOR SPECIALIST 

12 

16.00 
56.00 

6.40 

9.60 
26.80 
24.00 
47.50 

9.60 

22.30 

446.70 

612.70 

12.80 

16.00 

108.00 

25.20 



574.40 

268.70 

25.50 

198.00 

435.00 

252.00 

33.60 

10.00 

528.00 

510.60 

510.60 

638.20 

19.20 

28.00 

21.70 

44.00 

45.00 

12.00 

2.25 
2.50 
13.50 
7.50 
3.50 
8.00 



00 

50 
00 



8.00 

4.00 

23.00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



U5 



ILLINOIS 




.Health Care Servica 
Corporation 



Sixteen Localities: 
Cook County - Health Care 

Service Corporation 
l-l£ - Continental Casualty Co. 

(For more locality information 
see Appendix A) 



k6 



1977 PREVAILING CHARGE SUMMARY DATA HEALTH CARE SERVICE CORPORATION 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTlON OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 






COOK CO 

25.00 
50.00 
10.00 
10.00 
20.00 
35.00 
50.00 
15.00 
35.00 



18.00 
25.00 

56.25 



33.20 
600.00 

50.00 

600.00 

400.00 

50 . 00 

15.00 



750.00 

18.00 
30.00 
25.00 
30.00 
45.00 



3.00 
5.50 
8.50 



00 
00 
00 
00 
00 
00 



: ■ ■ '■,:y^<: : ^-^:^^yA[ 



10.00 

4.00 

15.00 

25.00 



ILLINOIS 

LOCALITY DESIGNATION FOR SPECIALIST 

COOK CO 

35.00 

60.00 

15.00 

15.00 

25.00 

50.00 

60.00 

15.00 

35.00 

750.00 

900.00 

23.00 

25.00 

200.00 

56.25 

300.00 

893.20 

33.20 

950.00 

500.00 

35.00 

350.00 

650.00 

400.00 

50.00 

15.00 

800.00 

700.00 

750.00 

700.00 

18.00 

30.00 

25.00 

45.00 

45.00 

24.00 

24.00 

3.50 

3.50 

9.00 

6 . 00 

4.00 

6.00 

5 . 00 

6.00 

6.00 

10.00 

5.00 

18.00 

60.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

1 1 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



hi 



1977 PREVAILING CHARGE SUMMARY DATA 



CONTINENTAL CASUALTY COMPANY 



ILLINOIS 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETEPI7ATT0N 

17 INSERTION OF PACEMAKER 

18 BLOOD T RAN FUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



01 



02 



03 



04 



05 



01 



02 



03 



04 



05 



12.00 


19.10 


1 5 . 00 


15.00 


25-50 


19. fO 


20-00 


19. 10 


25.00 


19.10 


Ot 


15.00 


21 .00 


23.00 


31.90 


30.00 


30.00 


35.00 


25.00 


35.00 


36.00 


02 


2.00 


7.70 


3.80 


3 . 00 


2.00 


4.90 


si 3.00 


3.80 


2.00 


4.00 


03 


6.40 


8.90 


7.70 


7.70 


8-90 


8.00 


- to. 20 


8.90 


10.00 


10.20 


04 


10.00 


15.00 


12.00 


12.00 


12.80 


15.00 


15.00 


15.00 


15.00 


19.10 


05 


19. 10 


20.00 


25.00 


25.00 


20.00 


30.00 


35.00 


30.00 


35.00 


30.00 


06 


25.00 


34.50 


25.00 


31 .90 


34.50 


44.40 


44.00 


38.00 


40.00 


38.30 


07 


7.70 


8.90 


3.90 


8.90 


8.90 


8.90 


11 .00 


10.00 


10.20 


10.20 


08 


15.00 


15.00 


15.00 


15.00 


15.00 


60.00 


60.00 


60.00 


60.00 


60.00 


09 


595.00 


595.00 


595.00 


595.00 


595-00 


500.00 


500-00 


500.00 


500.00 


500.00 


10 


850. OO 


850.00 


850.00 


850.00 


850.00 


850.00 


850.00 


850.00 


630.00 


612.50 


SB 1 1 


8.00 


10.00 


12.00 


10.00 


19.10 


5.00 


15.00 


10.00 


18. 00 


10.00 


1 2 


1 /OO 


12.80 


13.70 


10.00 


19.10 


10.00 


15.00 


1 . 00 


10.00 


10.00 


13 


150.00 


150.00 


1 50 . 00 


150.00 


1 50 . 00 


150.00 


150.00 


127.60 


150.00 


127.60 


14 


35/00 


44.70 


35.00 


25 . 00 


35.00 


50.00 


50.00 


50.00 


50.00 


40.00 


15 


18.70 


18.70 


18.70 


18.70 


18.70 


18.70 


18. 70 


18.70 


18.70 


18.70 


16 


1000.00 


1000.00 


1000.00 


1000.00 


1000.00 


1000.00 


1000. 00 


1000.00 


1000.00 


1000.00 


17 


13.80* 


14.40* 


13.00* 


13.60* 


17.80* 


10.80* 


17-40* 


15.60* 


17-60* 


19.40* 


18 


720.00 


720.00 


720.00 


720.00 


720-00 


675.00 


675.00 


669.00 


675.00 


600.00 


19 


276.00* 


288.00* 


272.00* 


272.00* 


356.00* 


216. 00* 


348.00* 


312. 00* 


352.00* 


388.00* 


20 


25.00 


25.00 


25.00 


30.00 


25.00 


25.00 


20.00 


25.00 


31.90 


31 .90 


21 


300.00 


300 . 00 


300.00 


300.00 


300-00 


200.00 


200.00 


200.00 


200.00 


200.00 


22 


425.00 


425.00 


425.00 


410.00 


425.00 


480.00 


450.00 


500.00 


450.00 


500.00 


23 


250.00 


250.00 


300.00 


250.00 


250.00 


3 1 9 . 00 


300.00 


300.00 


295.00 


279.00 


24 


45.00 


45.00 


45.00 


45.00 


45-00 


45.00 


40.00 


50.00 


38.30 


60.00 


25 


20.00 


20.00 


20.00 


20.00 


20.00 


12.00 


10.00 


5.00 


15.00 


9.00 


26 


640.00 


640.00 


640.00 


640.00 


640.00 


640.00 


650.00 


612.50 


612.50 


640.00 


27 


640.00 


640.00 


640.00 


640.00 


640.00 


640.00 


600.00 


638.00 


640.00 


495.00 


28 


600.00 


600.00 


600.00 


600 . 00 


600.00 


550.00 


550.00 


550.00 


550.00 


550.00 


29 


600.00 


600.00 


600.00 


600 . 00 


600 . 00 


650.00 


600.00 


500.00 


500.00 


510:40 


30 


12.00 


19.00 


12.00 


15.00 


19.10 


20.00 


17.00 


7.00 


20.00 


7.00 


31 


27.00 


31 .90 


27.00 


20.00 


2 1 . 70 


30.00 


30.00 


30.00 


30.00 


30.00 


32 


25.00 


25.00 


1 25.00 


25.00 


25.00 


30.00 


30.00 


30.00 


30 . 00 


30.00 


33 


46.00 


46.00 


46.00 


46.00 


38-30 


45.00 


47.50 


1 7 . 00 


45.00 


45.00 


34 


39.00 


39.00 


39.00 


39.00 


39-00 


42.00 


47.50 


42.00 


42.00 


15.00 


35 


15.00 


15.00 


15.00 


15.00 


15-00 


11 .00 


11 .00 


1 1 .00 


1 1 .00 


1 1 .00 


36 


20.00 


20.00 


20.00 


20.00 


20.00 


14.00 


14.00 


12.80 


14.00 


14.00 


37 


2.00 


3.00 


2.00 


3.00 


3.00 


2.50 


2.00 


3.00 


3.00 


4.00 


38 


1 .00 


3.00 


3.00 


2.00 


4.00 


2.50 


2.00 


2.50 


3.00 


3.00 


39 


6.00 


8.00 


6.50 


9.00 


1 . 00 


7.50 


9.50 


7.00 


8.00 


8.50 


40 


6.50 


6.00 


5 . 00 


7 . 00 


6.00 


6.50 


6.00 


6.00 


6.00 


6.00 


41 


3.00 


1 . 50 


3.00 


3.00 


3-00 


2.50 


2.00 


2.00 


3.00 


3.00 


42 


4.25 


8.00 


5.00 


5.50 


5-00 


4.00 


5.00 


4.0Q 


5.00 


5.00 


43 


5.00 


4.00 


3.50 


5.00 


5.00 


6.00 


4.00 


3.00 


4.00 


5.00 


44 


5.00 


6 . 00 i: 


: 6.00 


6.00 


6.00 


5.00 


5.00 


5.50 


5.00 


6.00 


45 


6.50 


7.00 


6.00 


7.00 


7.00 


5.00 


5.00 


6.00 


6.00 


7.00 


46 


10.00 


9.00 


10.00 


10.00 


10-00 


8.00 


6-00 


9.00 


10.00 


7.00 


47 


4.00 


3.00 


4.00 


5.00 


3.00 


4.00 


5.00 


4.00 


6.00 


4.00 


48 


15.00 


16.00 


15.0C 


20.00 


19.10 


17.00 


15.00 


14.50 


20.00 


19. 10 


49 


15.00 


15.00 


15.00 


15.00 


15.00 


16.00 


16.00 


16.00 


16.00 


16.00 


50 



U8 



1977 PREVAILING CHARGE SUMMARY DATA CONTINENTAL CASUALTY COMPANY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



ILLINOIS 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



.00* 
• 90 



06 

15.00 

19.10 

3.00 

7.70 

12.80 

30.00 

34.50 

8.90 

15.00 

595.00 

850.00 

10.00 

10.00 

150.00 

38.30 

18.70 

1000. CO 

17.20* 

720.00 

344. 

31 

300.00 

425.00 

250.00 

45.00 

20.00 

640.00 

640.00 

600.00 

600.00 

12.00 

27.00 

25.00 

46.00 

39 . 00 

15.00 

20.00 

3.00 

3.00 

6.00 

5.00 

3.00 

5.00 

4.00 

6.00 

5.00 

10.50 

5.50 

15.00 

15.00 



07 

16.00 
25.00 

2.00 

7.70 
10.00 
19.10 
34.50 

7.70 

15.00 

595.00 

850.00 

9 

7 



00 
00 



150.00 

35.00 

18.70 

1000.00 

11 .00* 

720.00 

220.00* 

25.00 

300.00 

425. CO 

250.00 

45.00 

10.00 

640.00 

640.00 

600.00 

600.00 

19.10 

27.00 

25.00 

46.00 

37.00 

15.00 

20.00 

2.50 

3.00 

5.00 

5.00 

3.00 

4.00 

4.00 

6.00 

6.50 

8.50 

4.00 

19.10 

15.00 



08 

1 5 . 30 

19.10 

3.00 

7.70 

15.00 

25.00 

34.50 

8.90 

15.00 

595.00 

850.00 

12.00 

12.00 

1 50 . 00 

27.50 

18.70 

1000.00 

14.00* 

720.00 

280.00* 

25.00 

300.00 

425.00 

250.00 

45.00 

20.00 

640.00 

640.00 

600.00 

600.00 

18.00 

24.00 

25.00 

46.00 

39.00 

15.00 

20.00 

3.00 

3.00 

7.00 

6.00 

3.00 

5.00 

4.00 

6.00 

5.00 

10.00 

3.00 

19.10 

15.00 



09 

15.00 

24.70 

2.00 

8.00 

15.00 

25.00 

35.00 

8.90 

15.00 

595.00 

850.00 

12.80 

10.00 

150.00 

35.00 

18.70 

1000.00 

15.00* 

720.00 

300.00* 

25.00 

300 . 00 

425.00 

250.00 

45.00 

20.00 

640 . 00 

640 . 00 

600.00 

600 . 00 

16.00 

19. 10 

25.00 

46 . 00 

39.00 

15.00 

20.00 



.00 
.00 



6.00 



00 
50 
00 
00 
00 
00 



10.00 

3.00 

19. 10 

15.00 



10 

1 5 . 00 

15.50 

3.00 

8.90 

15.00 

20.00 

34.50 

8. 90 

15.00 

595.00 

850.00 

10.00 

10.00 

150.00 

35.00 

18.70 

1000.00 

14.80* 

720.00 

296.00* 

26.00 

300.00 

425.00 

250.00 

45.00 

20.00 

640.00 

640.00 

600.00 

600.00 

17.00 

27.00 

25.00 

46.00 

39.00 

15.00 

20.00 

3.00 

3.00 

7.00 

6.00 

3.00 

5.00 

5.00 

5.00 

4.00 

10.00 

3.00 

20.00 

15.00 



06 

20.00 
21 .00 



90 
90 



15.00 
30.00 



.90 
00 



31 

1 1 

60.00 

500.00 

850.00 

10.00 

10.00 

150.00 

50.00 

18.70 

1000.00 

16.00* 

675.00 

320.00* 

25.00 

200.00 

485.00 

275.00 

35.00 

25.00 

640.00 

560.00 

550.00 

574.20 

8.50 

30.00 

30.00 

45.00 

42.00 

11.00 

14.00 

3.00 

4.00 

6.00 



00 
00 
00 
00 
00 



8.00 

8.00 

7.00 

15.00 

16.00 



07 

20.00 

25-50 

4.50 

8.90 

12.80 

25.50 

38.30 

8.90 

60.00 

500.00 

850.00 

15.00 

10.00 

100.00 

50.00 

18.70 

1000.00 

14.20* 

638.00 

284.00* 

25.00 

200.00 

400.00 

250.00 

38.30 

10.00 

640.00 

574.20 

550.00 

638.00 

20.00 

30.00 

30.00 

45.00 

42.00 

11 .00 

14.00 

2.50 

3.00 

7.00 

6.00 

3.00 

4.00 



00 
00 
00 
00 
00 



08 

18.00 

. 25.50 

3 . 00 

8.90 

15.00 

20.00 

30.00 

8.90 

60.00 

500.00 

500.00 

12.00 

10.00 

150.00 

50.00 

18.70 

1000.00 

16.60* 

595.00 

332.00* 

25.00 

200.00 

464.00 

287.10 

45.00 

8.00 

640.00 

427.00 

550.00 

600.00 

6.50 

30.00 

30.00 

45.00 

42.00 

1 1 .00 

14.00 



00 
00 
00 
00 
00 
00 
00 
00 
00 



09 

23.00 

25.00 

3.00 

10.00 

15.00 

35.00 

35.00 

10.00 

60.00 

500.00 

850.00 

9.00 

10.00 

150.00 

50.00 

18.70 

1000.00 

14. 60* 

675.00 

292.00* 

25.00 

200.00 

500.00 

300.00 

35.00 

5.00 

640.00 

500.00 

542.30 

510.40 

20.00 

30.00 

30.00 

45.00 

42.00 

11 .00 

14.00 

4.00 



10 



00 
00 



18.00 
16.00 



10.00 

7.00 

16.00 

16.00 



7.00 
4.00 
5.00 
5.00 
5.00 
5.00 
5.00 
7.00 



19. 10 
30.00 
3.80 
10.00 
12.80 
25.00 
44. 40 



10 

60, 
500, 
850. 

10. 

10, 
175. 

51 . 

18. 
1000. 

15. 



00 
00 
00 
00 
00 
00 
00 
00 
70 
00 
20* 



540.00 

304.00* 

25.00 



00 
00 
00 
00 



200 
300 
270 

25 

12.00 
480.00 
350.00 
550.00 
500.00 

18.00 

30 

30 

40 

44 

1 1 

14 
1 
4 



.00 
.00 
.00 
.70 
.00 
.00 
.50 
.00 



18.00 
16.00 



6.00 

5.00 

3.00 

5.00 

4.00 

4.00 

6.00 

10.00 

7.00 

16.00 

16.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



h9 



1977 PREVAILING CHARGE SUMMARY DATA CONTINENTAL CASUALTY COMPANY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



ILLINOIS 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 



11 



12 



13 



14 



15 



11 



12 



13 



14 



15 



01 INITIAL LIMITED OFFICE VISIT 


15.00 


15.00 


15.30 


1 2 . 80 


20.00 


20.00 


20.00 


19.10 


40.00 


25.50 


01 


02 INITIAL COMP OFFICE VISIT 


18.00 


35.00 


15.30 


19.10 


25.00 


31 .90 


31 .90 


25.00 


25.00 


31 .90 


02 


03 MINIMAL OFFICE VISIT 


5.00 


,4.00 


3.00 


2.60 


3.00 


2.60 


3 . 00 


3.00 


5.00 


5. 10 


03 


04 ROUTINE BRIEF OFFICE VISIT 


6.40 


','.70 


6.40 


7 . 70 


10.00 


8.90 


10-00 


7.70 


8.00 


12.00 


04 


05 ROUTINE BRIEF HOME VISIT 


1 2 . 00 


12.80 


10.00 


1 2 . 80 


19.10 


12.00 


15.00 


12.00 


12.80 


19. 10 


05 


06 INITIAL BRIEF HOSPITAL VISIT 


19. 10 


19.10 


25.00 


25.50 


30.00 


25.50 


25.50 


25.00 


25.00 


38.30 


06 


07 INITIAL COMP HOSPITAL VISIT 


6.00 


20.40 


34.50 


50'. 00 


31 .90 


55.00 


38-30 


44.40 


40.80 


50.00 


07 


03 ROUTINE BRIEF HOSPITAL VISIT 


8.00 


7.70 


10.00 


7.70 


12.00 


10.00 


10.20 


10.00 


10.00 


12.80 


08 


09 BIOPSY SKIN 


15.00 


15.00 


15.00 


15.00 


15.00 


60.00 


60-00 


60.00 


60.00 


60.00 


09 


10 RADICAL MASTECTOMY 


595.00 


595.00 


595.00 


595.00 


595.00 


408 . Oo 


500.00 


500.00 


500.00 


500.00 


10 


11 REDUCTION OF FRACTURE 


850.00 


850.00 


850.00 


850.00 


850.00 


500.00 


893.20 


850.00 


850.00 


765.60 


11 


12 ARTHOTMY 


5.00 


10.00 


12.00 


9.00 


1 5 . 00 


12.80 


10.00 


12.00 


12.00 


10.00 


12 


13 NEEDLE PUNCTURE OF BURSA - 


10.00 


6.00 


10.00 


9.00 


25.00 


10.00 


10.00 


10.00 


10.00 


20.00 


13 


14 BRONCHOSCOPY 


150.00 


150.00 


150.00 


150.00 


1 50 . 00 


95.70 


150.00 


150.00 


125.00 


175.00 


14 


15 THORACENTESIS 


35.00 


25.00 


25.00 


35.00 


35.00 


45.00 


44.70 


25.00 


35.00 


50.00 


15 


16 CATHETERIZATION 


18.70 


18.70 


18.70 


18.70 


18.70 


18.70 


18.70 


18.70 


18.70 


18.70 


16 


17 INSERTION OF PACEMAKER 


1000.00 


1000.00 


1000.00 


1000.00 


1000.00 


1000.00 


1000.00 


1000.00 


1000.00 


1000.00 


17 


18 BLOOD TRANFUSION 


9.60* 


12.00* 


13.20* 


11 .60* 


15.40* 


15.80* 


15-60* 


15. 60* 


15.00* 


22.40* 


18 


19 COLECTOMY 


720.00 


720.00 


720.00 


720.00 


720.00 


500.00 


400.00 


675.00 


675.00 


750.00 


19 


20 APPENDECTOMY 


192.00* 


240.00* 


264.00* 


232.00* 


308.00* 


316.00* 


312.00* 


312. 00* 


300.00* 


448.00* 


20 


21 SIGMOIDOSCOPY 


. 25.00 


20.00 


25.00 


20.00 


25.00 


25.00 


25.00 


25.00 


25.50 


35.00 


21 


22 HEMORRHOIDECTOMY 


300.00 


300.00 


300.00 


300.00 


300.00 


200.00 


200.00 


200.00 


200.00 


200.00 


22 


23 CHOLECYSTECTOMY 


425.00 


350.00 


425.00 


425.00 


425.00 


500.00 


450.00 


400.00 


450.00 


600.00 


23 


24 REPAIR HERNIA 


250.00 


250.00 


250.00 


250.00 


» 250.00 


275.00 


275-00 


300.00 


240.00 


325.00 


24 


25 CYSTOSCOPY 


45.00 


45.00 


45.00 


45.00 


45.00 


4J.00 


44.70 


45.00 


45.00 


50.00 


25 


26 DILATION OF URETHRA 


20.00 


30.00 


20.00 


20.00 


20.00 


5.70 


19.10 


12.00 


7.70 


10.00 


26 


27 PROSTATECTOMY 


640.00 


640.00 


640.00 


640.00 


640.00 


638.00 


550.00 


640.00 


600.00 


664.00 


27 


28 ELECTROSECTION OF PROSTATE 


640.00 


640.00 


640.00 


640 . 00 


640.00 


574.20 


550.00 


640.00 


535.90 


638.00 


28 


29 HYSTERECTOMY 


600.00 


600.00 


600.00 


600 . 00 


600.00 


550.00 


450.00 


550.00 


550.00 


550.00 


29 


30 EXTRACTION OF LENS 


600.00 


600.00 


600.00 


600 . 00 


600.00 


550.00 


550.00 


574.20 


510.40 


700.00 


30 


31 X-RAY CHEST 


12.80 


17.00 


12.80 


19. 10 


V. 18.00 


20.00 


20.00 


20.00 


20.00 


19. 10 


31 


32 X-RAY SPINE 


17.50 


27.00 


20.00 


15.00 


* 25.50 


30.00 


30.00 


30.00 


30.00 


30.00 


32 


33 X-RAY HIP 


25.00 


25.00 


25.00 


25.00 


W 25-00 


30.00 


20.00 


30.00 


30.00 


30.00 


33 


34 X-RAY STOMACH 


46.00 


46.00 


46.00 


44 . 70 


38.30 


45.00 


35.00 


45.00 


45.00 


38.30 


34 


35 X-RAY COLON 


39.00 


39.00 


39.00 


39.00 


38 . 30 


42.00 


38.30 


42.00 


42.00 


38.30 


35 


36 COBALT 


15.00 


15. CO 


15.00 


15.00 


15.00 


1 1 .00 


10.00 


1 1 .00 


11 .00 


15.30 


36 


37 RADIOTHERAPY 


20.00 


20.00 


20.00 


20.00 


20.00 


14.00 


8.00 


14.00 


14.00 


12.50 


37 


38 HEMOGLOBIN 


3.00 


3.00 


2.00 


2.00 


3.00 


4.00 


3.00 


3.00 


1 .00 


3.00 


38 


39 WHITE CELL COUNT 


4.00 


4.00 


2.00 


2.00 


3.50 


5.00 


4.00 


4.00 


3.00 


3.00 


39 


40 COMPLETE BLOOD COUNT 


6.00 


7.00 


7 . 00 


10.00 


8.00 


7.00 


9.00 


5.00 


9.50 


10.00 


40 


41 CHOLESTERAL BLOOD COUNT 


5.00 


6.00 


5.00 


6.00 


7.00 


8.00 


5.00 


5.00 


10.00 


5.50 


41 


42 HEMATOCRIT 


2.50 


3.00 


3.00 


2.00 


4 . 00 


2 . 00 


3-00 


4.00 


6.50 


3.00 


42 


43 PROTHROMBIN 


5.00 


4.50 


5.00 


5.00 ■ 


5 . 00 


5.00 


4.00 


4.00 


6.00 


5.00 


43 


44 SEDIMENTATION RATE 


: 5.00 


3 . 00 


5.00 


5.00 


5.00 


5.00 


4.00 


4 . 00 


4.90 


4.00 


44 


45 BLOOD SUGAR 


5.00 :: 


^.00 


' 5.00 


6.00 


6.00 


6.00 


6.00 


5.00 


7.00 


6.00 


45 


46 BUN UREA NITRATE 


6.00 


6.00 


5.00 


6.00 


6.00 


7.00 


6-00 


5.00 


6.00 


5.00 


46 


47 PAP TEST 


10.00 


8.00 


10.00 


10.00 


10.00 


10.00 


6.00 


7.00 


12.00 


10.00 


47 


48 URINALYSIS 


4.00 


3.00 


4.00 


5.00 


5.00 


4.00 


5.00 


7.00 


5.00 


7.00 


48 


49 ELECTROCARDIOGRAM 


15.00 


19. 10 


15.00 


19. 10 


15-00 


15.00 


19. 10 


20.00 


15.00 


16.00 


49 


50 ELECTROENCEPHALOGRAM 


15.00 


15.00 


15.00 


15.00 


15.00 


16.00 


16.00 


16.00 


16.00 


15.00 


50 



50 



INDIANA 



51 



INDIANA 




Three Localities: 

01 - Metropolitan 

02 - Urban 

03 - Rural 

(For more locality information 
see Appendix A) 



52 



1977 PREVAILING CHARGE SUMMARY DATA 



MUTUAL MEDICAL INSURANCE 



INDIANA 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



LOCALITY DESIGNATION FOR 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



REG 01 

25.00 
30.00 
10.00 
10.00 
15.00 
35.00 
35.00 
10.00 
25.00 



25.00 



15.00 



25-00 



15.00 



17.00 
25.00 
22.00 
44.00 
40.00 



3.00 
3.00 
7.00 
6.00 
3.00 
5.00 

- 5.00 
5.00 
7.00 

15.00 
3.00 

20.00 



REG 02 

1 5 . 00 
25.00 
9.00 
9.00 
14.00 
25.00 
25.00 
10.00 



15.00 
40.00 
15.00 
25.00 

15.00 



15.00 
20.00 



3.00 
3.00 
6.00 
6.00 
4.00 
5.00 



4.00 
5.00 
6.00 

10.00 
3.00 

18.00 



REG 03 

10.00 

25.00 

8.00 

8.00 

14.00 

25.00 

25.00 

8.00 



20.00 
25.00 
10.00 
25.00 

10.00 

1 5 . 00 
15.00 



3.00 
5.00 
6.00 
6.00 



00 
00 
00 
00 
00 



REG 01 

35.00 
45.00 
12.00 
12.00 
20.00 
50.00 
50.00 
12.00 

540.00 

585.00 

20.00 

150.00 
35.00 



630.00 

285.00 

35.00 

464.00 
300.00 
40.00 
12.00 
640.00 
640.00 
651 .00 
580.00 






26.00 

26.00 
22.00 
10.00 
12.00 



00 
00 
00 
00 
00 
50 



10.00 

3.00 

18.00 



4.00 

6.00 

7.00 

10.00 

3.00 

20.00 

40.00 



REG 02 

20.00 
35.00 
10.00 
10.00 
15.00 
40.00 
40.00 
10.00 



630.00 
24.00 

125.00 
25.00 



20.00 
552.00 
285.00 

30.00 

450.00 
275.00 
43.60 
10.00 
560.00 
560.00 

550.00 
9.50 
23.00 
10.00 
24.00 
24.00 
10.50 
17.00 



00 
00 



8.00 
5.50 



00 
00 
50 
00 
00 



SPECIALIST 

REG 03 

60.00 
30.00 
10.00 
1 . 00 
15.00 
35.00 
35.00 
10.00 



25.00 



10.00 
500.00 

25.00 

400.00 
275.00 



500:00 
11 .00 



6.00 

4.50 

18.00 

40.00 



4.00 
20.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



53 



IOWA 



OKI OCA CKCMHWX 




O *aSQn Cirr 

CCMO OC»0O 



— 7 ' 



»»« T4T1.0* 




Eight Localities: 

01 - Lee, Van Buren, Des Moines, Henry, Jefferson, Louisa, 

Washington, Muscatine, Johnson (excluding Iowa City), Iowa, 
Edar & Scott Counties 

02 - Clinton, Jackson, Jones, Linn, Buchanan, Delaward, Dubuque, 

Clayton, Fayette, Alamakee <£ Winneshiek Counties 

03 - Black Hawk, Grundy, Hardin, Hamilton, Wright, Cerro Gordo, 

Floyd, Chickasaw, Howard, Mitchell, Worth, Winnebago, Hancock, 
Franklin, Butler 4 Brenner 

04 - Denton, Tanna, Marshall, Story, Casper, Paweshiek, Keokuk, 

Mahaska, Marion, Wapello, Monroe, Lucas, Clarke, Davis 
Appanoose, Decator Counties 



0$ - Folk 4 Warren Counties 

06 — Kossuth, Humboldt, Webster, Calhoun, Pocahontas, Palo Alto, 

Bnmet, Dickinson, Bueno Vista, Clay, Sac, Ida, Woodbury, 
Cherokee, Plymouth, O'Brien, Souix, Lyon & Osoelola Counties 

07 — Monora, Crawford, Carroll, Greene, Boone, Harrison, Shelby, 

Audubon, Guthrie, Dallas, Madison, Adair, Cass, Pottawattamie, 
Hills, Montgomery, Adar.s, Union, Fremont, Page, Taylor, 4 
Ringold Counties 

08 - Iowa City ( Includes the University of Iowa hospital. 

The city limits are the boundaries of the locality.) 

"Note: Specialists only 

5h 



1977 PREVAILING CHARGE SUMMARY DATA 



B/S OF IOWA 



IOWA 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKEP 

18 BLOOD T RAN FUSION ' 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA , > 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 
01 02 03 04 05 



LOCALITY DESIGNATION FOR SPECIALIST 

01 02 03 04 05 



18 

25. 

8. 

8. 
12. 

19. 
19. 

7. 
17. 
400. 
480. 
81 . 
19. 
96. 
12. 
280. 
480. 
12. 
720. 
225 
25 
200 
325 
200 
63 
12 
480 
480 
382 
480 
15 
25 
15 
21 
25 
24 
24 
2 
3 
7 
7 
3 
5 
3 
5 
5 
12 
3 
17 
29 



00 

50 

00 

00 

00 

10 

10 

70 

70 

00* 

00* 

00 

10 

00* 

80 

00* 

00* 

80 

00* 

00 

00 

00* 

00 

.00 

.80 

.80 

.00* 

.00* 

.80 

.00* 

.00 

.00 

.00 

.00* 

.50 

.00* 

.00* 

■ 50 
.00 
.00 
.00 
.00 
.00 

■ 00 
• 50 
.00 
.00 
.00 
.50 
.50* 



19. 

25. 
7. 
7. 

12. 

25. 

25. 
7. 

17. 
400. 
480. 

14. 

15. 

96. 

30. 
280. 
480. 

12. 
720. 
229. 

25. 
200. 
382. 
236. 



00 

00 

00 

70 

50 

50 

50 

70 

50 

00* 

00* 

00 

30 

00* 

00 

00* 

00* 

80 

00* 

70 

00 

00* 

80 

10 



6.40 

480.00* 

480.00* 

382.80 

480.00* 

15.30 

19. 10 

15.00 

24.00* 

35.00 

24.00* 

24.00* 



00 
50 
00 
00 
50 
00 
00 
75 
00 
00 
00 



18.00 
31 .00* 



19 

19 

8 

8 

11 

25 

25 

7 

17 

400 

480 

16 

16. 

96. 

35. 

280. 

480. 

19. 

720. 

223. 

19. 

200. 

400. 

229. 

63. 

15. 

480. 

480. 

328. 

480. 

12. 

20. 

15. 

28. 

31 . 

24. 

24. 

3. 

3. 

8. 

5. 

2. 

5. 

5. 

5. 

6. 

8. 

3. 

20. 

30. 



.10 
.10 

.00 
.00 

■ 50 

■ 00 
.00 
.70 

50 
.00* 
.00* 
.00 
.00 
.00* 
.00 
.00* 
.00* 
.10 
.00* 

• 30 
-10 

■ 00* 

■ 00 
70 

.80 
.00 
.00* 
.00* 
.80 
.00* 
80 
.00 
.00 

• CO* 
90 
00* 
00* 
00 
00 
00 
00 
50 
00 
00 
00 
00 
00 
00 
00 
00* 



18.00 
25.00 



50 
50 



12.00 

24.20 

24.20 

8.90 

17.50 

400.00* 

480.00* 

19. 10 

19. 10 

96.00* 

25.50 

280.00* 

480.00* 

12 .80 
720.00* 
240 . 00 
19. 10 
200.00* 
382.80 
191.40 
63.80 
12.80 
480.00* 
480.00* 
382.80 
480.00* 
16.50 
20.00 I 
16.50 
21 -30* 
35.00 
24.00* 
24.00* 



00 
00 
00 
00 
00 
00 
00 



20.00 

25.00 

8.50 

8.5O 

12.80 

25.00 

25.00 

8.9O 

17.50 

400.00* 

480.00* 

15.00 

15.00 

96.00* 

30.00 

280.00* 

480.00* 

15.00 

720.00* 

250.00 

25.00 

200-00* 

282.80 

223.30 

63.80 

12.80 

480.00* 

480.00* 

582.80 

480.00* 

1 8 . 00 

20.00 

12.80 

21 .90* 

35.00 

24.00* 

24.00* 

2.50 

3.00 

8.50 



00 
00 
00 



5.00 
5.00 
8.00 
3.00 
20.00 
29.00* 



4.00 
5.00 
6.00 
7.50 
4. 00 
20.00 
33.00* 



25.00 

31.90 

8.00 

8.O0 

10.00 

35.00 

35.00 

8.90 

23.00 

446.60 

528.00* 

19.10 

15.30 

127.60 

44.70 

280.00* 

480.00* 

15.00 

720.00* 

255.20 

27.50 

200.00* 

446.60 

255.20 

63.80 

12.80 

5 1 . 40 

510.40 

475.00 

542.30 

15.30 

25.00 

19.10 

19.10 

31.90 

24.00* 

24.00* 

2.00 

2.50 

8.00 

5.00 

2.00 

4.00 

2.0Q 

6.00 

6.00 

10.00 

3.00 

15.00 

35.00* 



35.00 

35.00 

9.00 

9.00 

12.80 

40.00 

40.00 

9.00 

23.00 

465.00 

480.00* 

25.00 

15.30 

127.60 

50.00 

280.00* 

480. 00* 

12.80 
765.00* 
275.00 
25.50 
212.50* 
400.00 
250.00 
56.00 
15.30 
510.40 
500.00 
497.60 
500 . 00 
18. SO 
19.10 
19.10 ;: 
25.00 
35.00 
24.00* 
24.00* 



00 
00 



8.00 
6.00 
3.00 
4.00 
3.00 
6.00 



00 
00 
00 



15.00 
35.00* 



25.50 

. 25.00 

10.00 

10.00 

19. 10 

38.30 

38.30 

10.20 

23.00 

500.00 

480.00* 

15.30 

108.50 

31 .90 

280.00* 

480.00* 

15.00 

792.00* 

255.00 

19.10 

220.00* 

446.60 

255.20 

48.00 

12.00 

510.40 

574.20 

446.60 

500.00 

1 2 . 50 

19. 10 

8.90 

10.20 

15.30 

24.00* 

24.00* 

2.25 

2.25 

8.00 

6.00 

2.25 

3.00 

5.00 

5.00 

6.50 

6.00 

4.00 

17.00 

35.00* 



31 .90 

50.00 

8.00 

8.00 

12.00 



31 
31 



90 
90 



10.00 
23.00 
457.00 
480.00* 
19.10 
12.80 
95.70 
15.80 
280.00*'* 
480.00** 
14.00 ' 
720.00* 
250.00 
19.10 
200.00* 
350.00 
225.00 i 
25.00 
12.80 
510.40 
510.40 
480.00 
500.00 
19.10 
25.00 
19.10 
19. 10 
35.00 
24.00* 
24.00* 



00 
00 



10.00 
5.00 
3.00 
4.20 
3.00 
5.00 
7.00 

10.00 
4.00 

20.00 

35.00* 



33 

35 

10 

10 

15 

40 

40 

10 

23 

500 

480 

19 

15 

150 

31 . 

280. 

480. 

15. 

828. 

266. 

30. 

230. 

435. 

255. 

95. 

12. 

510. 

510. 

510. 

510. 

18. 

19. 

12. 

19. 

31 . 

24. 

24. 

3. 

3. 

8. 

6. 

2. 

5. 

2. 

6. 

6. 

7. 

3. 

17. 

35. 



.20 

.00 

.00 

.00 

.00 

.00 

.00 

.00 

.00 

.00 

.00* 

. 10 

.30 

.00 

.90 

.00* 

. 00* 

.00 

.00* 

.70 

.00 

.00* 

.00 

.20 

.70 

.00 

.40 

.40 

.40 

40 

50 

10 

80 

10 

90 

00* 

00* 

00 

00 

00 

00 

00 

00 
00 
00 
00 
50 
00 
00 
00* 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

1 2 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



55 



1977 PREVAILING CHARGE SUMMARY DATA B/S OF IOWA 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 
PROCEDURE DESCRIPTION 06 07 08 



IOWA 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



INITIAL 
INITIAL 
MINIMAL 
ROUTINE 
ROUTINE 
INITIAL 
INITIAL 
ROUTINE 
BIOPSY 



LIMITED OFFICE 
COMP OFFICE 
OFFICE VISIT 
BRIEF OFFICE VISIT 

HOME VISIT 

HOSPITAL VISIT 

HOSPITAL 

HOSPITAL 



BRIEF 
BR I EF 
CCMP 
BRIEF 
SKIN 



VISIT 
VISIT 



VISIT 
VISIT 



RADICAL MASTECTOMY 

REDUCTION OF FRACTURE 

ARTHOTMY 

NEEDLE PUNCTURE OF BURSA 

BRONCHOSCOPY 

THORACENTESIS 

CATHETERIZATION 

INSERTION OF PACEMAKER 

BLOOD TRANFUSION 

COLECTOMY 

APPENDECTOMY 

SIGMOIDOSCOPY 

HEMORRHOIDECTOMY 

CHOLECYSTECTOMY 

REPAIR HERNIA 

CYSTOSCOPY 

DILATION OF URETHRA 

PROSTATECTOMY 

ELECTROSECTION OF PROSTATE 

HYSTERECTOMY 

EXTRACTION OF LENS 

X-RAY CHEST 

X-RAY SPINE 

X-RAY HIP 

X-RAY STOMACH 

X-RAY COLON 

COBALT 

RADIOTHERAPY 

HEMOGLOBIN 

WHITE CELL COUNT 

COMPLETE BLOOD COUNT 

CHOLESTERAL BLOOD COUNT 

HEMATOCRIT 

PROTHROMBIN 

SEDIMENTATION RATE 

BLOOD SUGAR 

BUN UREA NITRATE 

PAP TEST 

URINALYSIS 

ELECTROCARDIOGRAM 

ELECTROENCEPHALOGRAM 



19 

26 
7 
7 

10 
25 
25 
8 
17 
400 
480 
18 
19 
96 
19 
280 
480 
12 
720 
225 
19 
200. 
400. 
250. 
63. 
15. 
480. 
480. 
400. 
480. 
15. 
22. 
19. 
24. 
35. 
24. 
24. 
3. 
3. 
7. 
6. 
3. 
5. 
3. 
6. 
6. 
10. 
3. 
20. 
32. 



.10 

• 00 

.00 

.00 

-20 

.00 

.00 

.90 

-50 

.00* 

.00* 

.00 

.10 

.00* 

.10 

.00* 

.00* 

.80 

.00* 

.00 

-10 

.00* 

.00 

.00 

.80 

.00 

.00* 

.00* 

00 

00* 

00 

00 

10 

00* 

00 

00* 

00* 

00 

00 

00 

00 

00 

00 

50 

00 

00 

00 

00 

00 

00* 



16 

15 
7 
7 
12 
25 
25 
8 
17 
400 
480 
16 
12 
96 
30 
280 
480 
15 
720 
200 
25 
200 
331 
200 
25 
12 
480 
480 
382 
480. 
15. 
20. 
15. 
22. 
35. 
24. 
24. 
3. 
3. 
8. 
6. 
4. 
5. 
4. 
yv 6 . 
7. 
12. 
3. 
20. 
35. 



■ 60 
.00 
.00 
.00 
.00 
.00 
.00 

■ 90 

• 50 
.00* 
.00* 
.00 

■ £0 
.00* 

• 00 
.00* 
.00* 
.00 
.00* 
.00 

• 50 

• CO* 

• 80 
-00 
.00 
.80 
.00* 
.00* 

• 80 
.00* 
.00 
.00 
.00 

• 80* 
.00 
.00* 
.00* 
.00 
.00 
.00 
.00 
.00 

00 
00 
.00 
00 
00 
00 
00 
00* 



LOCALITY 




06 


25 


00 


44 


.70 


10 


.00 


10 


00 


12 


80 


44 


.70 


44 


70 


8 


90 


23 


00 


475 


00 


480 


00* 


19 


10 


15 


30 


95 


70 


31 


90 


280 


00* 


480 


00* 


15 


00 


792 


00* 


285 


.00 


25 


00 


220 


00* 


446 


60 


270 


00 


65 


00 


9 


60 


510 


40 


560 


00 


425 


00 


500 


00 


12 


00 


25 


00 


19 


10 


19 


10 


35 


00 


24 


00* 


24 


00* 


3 


00 


3 


00 


8 


00 


7 


50 


2 


00 


4 


00 


3 


00 


5 


00 


8. 


00 


10 


00 


3. 


00 


18. 


00 


35. 


00* 



DESIGNATION FOR SPECIALIST 

07 08 



30 

40 

10 

10 

12 

44 

44 

12 

23 
4 75. 
480. 

19. 

15. 
127. 

26. 
280. 
480. 

12. 
720. 
257. 

30. 
200. 
440. 
260. 

60. 

12. 
510. 
560. 
478. 
446. 

16. 

25. 

20. 

19. 

35. 

24. 

24. 
3. 
2. 
9. 
7. 
2. 
4. 
5. 
6. 
7. 

10. 
5. 

20. 

35. 



.00 

.00 

.00 

.00 

.60 

.70 

.70 

.00 

.00 

.00 

.00* 

.10 

.30 

.60 

.80 

.00* 

. 00* 

.80 

. 00* 

.00 

.00 

.00* 

.00 

.00 

.00 

.80 

.40 

.00 

.50 

.60 

.60 

.00 

.00 

.10 

.00 

00* 

00* 

2 

50 

00 

50 

00 

20 

25 

00 

50 

50 

00 

00 

00* 






25.00 

70.00 

19.10 

19. 10 

12.80 

70.00 

70.00 

9.00 

23.00 

475.00 

480.00 

19. 10 

15.30 

127.60 

31 .90 

280.00 

480.00 

15.00 

720.00 

255.20 

31 .90 

200.00 

5 1 . 40 

270.00 

25.00 

15.00 

510.40 

550.00 

450.00 

750.00 

18. 50 
25.00 

19. 10 
19. 10 
35.00 
24.00 
24.00 

3.00 
3.00 
8.00 



00 
00 
20 
00 
00 
00 



10.50 

3.50 

18.00 

35.00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
20 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



56 



KANSAS 



57 



KANSAS 




Three Localities: 

Blue Shield of Kansa3 

01 - Blue Shield of Kansas Plan area (102 counties) 

Blue Shield of Kansas City 
IV — Johnson County (suburban) 
V - Wyandotte County (metropolitan) 



58 



1977 PREVAILING CHARGE SUMMARY DATA 



B/S OF KANSAS 



KANSAS 



COMBINED LOCALITY DESIGNATION 



PROCEDURE DESCRIPTION 



SINGLE 



01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE 8RIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X- RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



: '.'■ ■■;•;:::■ 7 ' ... 



'S¥:vXCvS: : :^ : : : : : : : S : : : : : S ; :7 : : : : ; ;^^ 



20.00 
35 . 00 
8.00 
4.50 
15.00 
30.00 
50.00 
9.60 
24.00 
560.00 
600.00 
16.80 
20.00 
159.50 
31 .90 
210.00 
600.00 
15.00 
638.00 
268-00 
30.00 
229.70 
450.00 
260.30 
63.80 
20.00 
612.50 
550.00 
543.60 
510.40 
1 6 . 00 
25.00 
25.00 
48.00 
45.20 
14.00 
25.50 
4.00 
5.00 
9.00 
8.00 
4.00 
6.00 
4.50 
6.00 
8.00 
10.00 
5.00 
20.00 
52.00 



■ :'■'"':■. "■■': ■ ■:'■ ■' " ;: : - ':■>:■:■: :.":":': 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 

11 

12 
13 

!2 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



59 



1977 PREVAILING CHARGE SUMMARY DATA B/S OF KANSAS CITY , MISSOURI 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 
PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



AREA 04 


AREA 05 


25.00 


25.00 


25.00 


25.00 


5.00 


5.00 


10.00 


1 . 00 


15.00 


1 5 . 00 


25.00 


35.00 


35.00 


35.00 


12.00 


10.00 


35.00 


35.00 


615.00 


6 1 5 . 00 


530.00* 


335.00* 


15.00 


15.00 


12.50 


12.50 


135.00 


1 35 . 00 


25.00 


25.00 


175.00 


175.00 


600.00 


600 . 00 


22.50* 


20.00* 


1166.00* 


737.00* 


350.00 


350.00 


20.00 


20.00 


285.00 


285.00 


500. CO 


500 . 00 


250.00 


250 . 00 


65.00 


65.00 


23.00 


23.00 


685.00 


6B5.00 


560.00 


560 . 00 


575.00 


575.00 


550.00 


550.00 


1 8 . 00 


20.00 


30 . 00 


20.00 


15.00 


17.00 


45.00 


45.00 


40.00 


40 . 00 


5.00 


3.00 


4.00 


3.00 


10.00 


8 . 00 


7 . 00 


6.00 


3.00 


3.00 


6.00 


5 . 50 


6.00 


4.00 


6 . 00 


5.00 


8.00 


5.00 


10.00 


10.00 


5.00 


5.00 


17.50 


15.00 


50.00 


50.00 



KANSAS 
LOCALITY DESIGNATION FOR SPECIALIST 
AREA 04 AREA 05 



35.00 

35.00 

15.00 

10.00 

20.00 

45.00 

50.00 

12.00 

25.00 

650.00 

590.00* 

40. 00 

15.00 

140. 00 

50.00 

175.00 

600.00 

53.00* 

1 166.00* 

350.00 

35.00 

300.00 

500.00 

350.00 



40.00 

40.00 

6.00 

10.00 

15.00 

50.00 

45.00 

15.00 

25.00 

650.00 

340.00* 

15-00 

15.00 

140.00 

50.00 

175.00 

600.00 

43.50* 
957.00* 
350.00 
30.00 
300.00 
500.00 
300.00 





575.00 


575.00 




15.00 


15-00 




30.00 


30 . 00 




22.00 


22.00 


' 


46.00 


46.00 




39.75 


39.75 




3.00 


5.00 




5.00 


4.00 




8.00 


16.00 




8.00 


6.00 




4.00 


3.50 




3.00 


10.00 




5.00 


5.00 


^'-v*:*:*:*:*:*:' 


6.00 


6.75 




6.00 


6.75 




9.00 


10.00 




4.50 


5.00 




15.00 


20.00 




50.00 


50.00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



6o 



KENTUCKY 


















61 



KENTUCKY 






..... \? / 



OU'SVlUf ^ ..^i..«i 







5T0N 

vtdn' 

.... ! \— ) — X' 
K y \ S 

| \v /«UMlU^- 



Ad 




HUNTINGTCNASHLAND 



re »+ .f 5+^tt - in 



Thrse Localities: 

J -Metropolitan- Lexington (Fayette County) , Louisville ( including 
Anchorage, Croctwood, Jeffersor.town, Lyndon, Middletown, Okalona, 
Pee Wee Valley, Measure Ridge Park, Shivcly, St. Matthews, 
Valley Station). 

II -Urban- Ashland ( including Grayson, Greenup, Westwood), Eardstown, 
Bellevue, Bowling Green, Catlettsburg, Covington (including 
Alexandria, Ercrley, Burlington, Dayton, Elsnere Park, Ft. Mitchell, 
South Hills, Southgate, Walton, Woodlawn), Danville, Elizabethtown 
(including Lebanon Junction), Florence, Fort Thomas, Frankfort (including 
Midway) , Georgetown, Glasgow, Harlan, Hazard (including White sburg) , 
Henderson, Hopkinsville (including Eikton, Fairview), Lancaster, 
Lawrenceburg, Louisa, Kadisonville , Mayfield, Middlesboro, Morehead, 
Korganfield, Mount Sterling, Murray, Newport, Nicholasville , 
Owensboro, Paducah (including West Paducah) , Paris, Pikevi lie, 
Pineville, Prestonsburg, Richmond, Shelbyville, Stanford, Versailles, 
Vine Grove, Winche.ster( including Carlisle, Stanton). 

HI -Rural- All other areas of the State. 62 



1977 PREVAILING CHARGE SUMMARY DATA METROPOLITAN LIFE INSURANCE CO. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



KENTUCKY 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION I 

01 INITIAL LIMITED OFFICE VISIT 12.80 

02 INITIAL COMP OFFICE VISIT 25.00 

03 MINIMAL OFFICE VISIT 5.00 

04 ROUTINE BRIEF OFFICE VISIT 8-90 

05 ROUTINE BRIEF HOME VISIT 15.00 

06 INITIAL BRIEF HOSPITAL VISIT 25.50 

07 INITIAL COMP HOSPITAL VISIT 40.00 

08 ROUTINE BPIEF HOSPITAL VISIT 10.00 

09 BIOPSY SKIN 19.10 

10 RADICAL MASTECTOMY 446.60 

11 REDUCTION OF FRACTURE 510-40 

12 ARTHOTMY 15.30 

13 NEEDLE PUMCTURE OF BURSA 13.00 

14 BRONCHOSCOPY 95.70 

15 THORACENTESIS 19.10 

16 CATHETERIZATION 223.30 

17 INSERTION OF PACEMAKER 638.00 

18 BLOOD TRANFUSION 17.50 

19 COLECTOMY 510.40 

20 APPENDECTOMY 255.20 

21 SIGMOIDOSCOPY 15.00 

22 HEMORRHOIDECTOMY 191.40 

23 CHOLECYSTECTOMY 382-80 

24 REPAIR HERNIA 223.30 

25 CYSTOSCOPY 31 .90 

26 DILATION OF URETHRA 10.00 

27 PROSTATECTOMY 500.00 

28 ELECTROSECTION OF PROSTATE 490.00 

29 HYSTERECTOMY 446.60 

30 EXTRACTION OF LENS 500.00 

31 X-RAY CHEST 15.00 

32 X-RAY SPINE 20.00 

33 X-RAY HIP 20.00 

34 X-RAY STOMACH 35.00 

35 X-RAY COLON 31 .90 
35 C00;i. T '5.00 

37 RADIOTHERAPY 24.00 

38 HEMOGLOBIN 3.00 

39 WHITE CELL COUNT 3.00 

40 COMPLETE BLOOD COUNT 7.00 

41 CHOLESTERAL BLOOD COUNT 6.00 

42 HEMATOCRIT 3.00 

43 PROTHROMBIN 5.00 

44 SEDIMENTATION RATE 6.00 

45 BLOOD SUGAR 6.00 

46 BUN UREA NITRATE 6.00 

47 PAP TEST 10.00 

48 URINALYSIS 4.00 

49 ELECTROCARDIOGRAM 15.00 

50 ELECTROENCEPHALOGRAM 35.00 



II 

12.00 

30.00 

5.00 

7.70 

12.80 

19. 10 

37.00 

9.00 

19.10 

446.60 

5 1 . 40 

12.80 

15.00 

95.70 

19.10 

210. 



.00 

.00 

50 

.40 

20 

10 



638. 

15. 
510. 
255. 

19. 
191 .40 
382.50 
223.30 

31 

10. 
420. 
510. 
446. 
500. 



■ 90 
.00 
.00 
.40 
.60 
• 00 



15.00 
19. 10 
19.00 



36 
31 
10 
10, 

2 

3, 

6. 

6. 

2. 



00 
90 
00 
CO 
50 
00 
00 
CO 
00 



5-00 
3.50 
6.00 



5 
10. 

3 
18, 

40. 



00 
00 
00 
50 
00 



III 



I 



1 2 . 80 


19.10 


31 .90 


44.70 


5.10 


6.40 


6.40 


10.20 


10.00 


15.00 


19.10 


31 .90 


35.00 


50.00 


7.70 


12.00 


20.00 


30.00 


507.50 


600.00 


510-40 


701 .80 


12.00 


1 5 . 00 


1 . 00 


15.00 


95 . 70 


127.60 


25.00 


40.00 


253.80 


223.00 


725.00 


638.00 


14.50 


17.50 


580.00 


638.00 


290.00 


319.00 


25.00 


20.00 


200.00 


265.00 


420.00 


478.50 


253.80 


310.00 


31 -90 


31 .90 


10.00 


10.00 


580.00 


500.00 


510.40 


516.80 


446.60 


550.00 


375.00 


500.00 


12.50 


15.00 


20.00 


25.00 


20.00 


20.00 


31 -90 


40.20 


31 .30 


31.90 


18.30 


20.00 


24.20 


27.00 


2.50 


3.00 


3.00 


4.00 


6.50 


7.00 


7.00 


6.50 


3.00 


2.50 


5.00 


5.00 


4.00 


5.00 


6.00 


6.00 


6.00 


6.00 


10.00 


8.00 


3.00 


4.00 


16.00 


16.50 


47.00 


35.00 



II 



III 



15.00 


12.80 


01 


38.30 


25.00 


02 


7.70 


5.00 


03 


7.70 


7.70 


04 


15.00 


12.80 


05 


19. 10 


19. 10 


06 


44.70 


40.00 


07 


10.00 


8.90 


08 


25.00 


25.00 


09 


540.00 


510.40 


10 


574.20 


510.40 


: 11 


15.00 


19. 10 


12 


15.00 


15.00 


13 


145.00 


100.00 


14 


50.00 


31 .90 


15 


2 1 . 00 


268.00 


16 


750.00 


765.60 


17 


28.00 


16.00 


18 


600.00 


638.00 


19 


3 1 9 - 00 


3 1 9 . 00 


20 


25.00 


25.00 


21 


265.00 


200.00 


22 


446.60 


420.00 


23 


300.00 


255.20 


24 


35.00 


31 .90 


25 


10.00 


10.00 


26 


420.00 


6 1 2 . 50 


27 


510.40 


5 1 . 40 


28 


542.30 


446.60 


29 


500.00 


375.00 


30 


12.80 


12.80 


31 


22.00 


24.20 


32 


19.00 


20.00 


33 


40.20 


38.30 


34 


33.60 


38.30 


35 


19. 10 


18.30 


36 


24.20 


24.20 


37 


3.00 


3.00 


38 


3.00 


3.00 


39 


7 . 50 


7 . 00 


40 


6.50 


6.00 


41 


3.00 


3.00 


42 


5.00 


6.00 


43 


5.00 


4.00 


44 


6.00 


6.00 


45 


6.00 


7.00 


46 


8.50 


10.00 


47 


4.00 


3.00 


48 


19.00 


18.00 


49 


40.00 


52.50 


50 



63 



LOUISIANA 




Eight Localities: 

01 - Orleans Parish, Jefferson, St. Bernard, Plaquemines Parishes 

02 - Caddo, Bossier Parishes 

03 - East Baton Rouge, West Baton Rouge Parishes 

04 - Calcasieu Farish 

05 - Ouachita Parish 

06 - Lafayette, Iberia, St. Martin Parishes 

07 - Hapides Parish 

50 - All other Parishes 



6U 



1977 PREVAILING CHARGE SUMMARY DATA 



PAN-AMERICAN LIFE INSURANCE CO. 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTEROL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



01 



02 



03 



04 



05 



LOUISIANA 
LOCALITY DESIGNATION FOR SPECIALIST 

01 02 03 04 05 



20.00 


16.00 


19.10 


7.00 


17.00 


30.00 


35.00 


31 .90 


30.00 


.. 20.00 


01 
02 
03 
04 


8.90 


7.70 


8.00 


7.00 


6. 40 


10.00 


10.00 


10.00 


10.20 


10.20 


15.30 


15.00 


10.00 


12.80 


10.20 


19.10 


24.90 


15.00 


12.80 


15.00 


05 
06 


12.80 


10.00 


10.00 


12.50 


13.10 


15.00 


15.00 


12.80 


15.00 


12.80 


07 

08 


20.00 


20.00 


20.00 


20.00 


20.00 


25.00 


25.00 


25.00 


25.00 


25.00 


09 


638.00 


638.00 


638.00 


638.00 


638.00 


600.00 


600.00 


638.00 


600.00 


600.00 


!H 10 


638.00 


638.00 


638.00 


638.OO 


638.00 


701.80 


600.00 


600.00 


638.00 


550.00 


11 


8.00 


15.00 


12.00 


10.00 


1 . 00 


10.00 


15.00 


12.80 


15.00 


12.80 


12 


15.00 


15.00 


15.00 


15.00 


15.00 


10.00 


10.00 


1 5 . 00 


10.00 


10.00 


13 


175.00 


1 75 . 00 


175.00 


175.00 


1 75 . 00 


150.00 


150.00 


150.00 


150.00 


150.00 


14 


35.00 


35.00 


35.00 


35.00 


35.00 


50.00 


50.00 


50.00 


50.00 


50.00 


15 


319.00 


319.00 


3 1 9 . 00 


319.00 


319.00 


3 1 9 . 00 


319.00 


319.00 


319.00 


3 1 9 . 00 


16 


750.00 


750.00 


750.00 


750.00 


750.00 


750.00 


750.00 


750.00 


750.00 


750.00 


17 


10.00 


10.00 


10.00 


10.00 


10.00 


14.80* 


10.00 


10.00 


10.00 


10.00 


18 


750.00 


750.00 


750.00 


750.00 


750.00 


750.00 


750.00 


750.00 


750.00 


750.00 


19 


286.00 


286.00 


286.00 


286.00 


286-00 


286.00 


286.00 


286.00 


286.00 


286.00 


20 


31 .90 


25.00 


20.00 


30.00 


25.00 


30.00 


25.00 


20.00 


31 .90 


25.00 


21 


319.00 


319.00 


3 1 9 . 00 


319.00 


3 1 9 . 00 


350.00 


350.00 


350.00 


350.00 


350.00 


22 


40.00 


450.00 


450.00 


450.00 


450.00 


630.00 


500.00 


425.00 


400.00 


450.00 


23 




285.00 


285.00 


285.00 


285.00 


350. OQ 


300.00 


305.00 


300.00 


300.00 


24 




40.00 


40.00 


40.00 


40.00 


45.00 


31.90 


42.50 


10.00 


38.00 


25 


14.00 


14.00 


14.00 


14.00 


14.00 


10.00 


15.00 


4.00 


10.00 


10.00 


26 


638.00 


638.00 


638.00 


638.OO 


638.00 


660.00 


600.00 


600.00 


600.00 


600.00 


27 


560.00 


560.00 


560.00 


560.00 


560.00 


600.00 


530.00 


485.00 


550.00 


550.00 


28 


540.00 


540.00 


540.00 


540 . 00 


540.00 


525.00 


540.00 


525.00 


525.00 


525.00 


29 


600.00 


600.00 


600.00 


600 . 00 


900.00 


600.00 


600.00 


600.00 


510.00 


510:00 


30 


19.00 


15.00 


17.50 


16.00 


1 5 . 00 


18.50 


19.00 


19.10 


17.00 


19. 10 


31 


44 . 70 


44. 70 


44.70 


44.70 


44.70 


44.70 


44.70 


44.70 


44.70 


44. 70 


32 


20.00 


20.00 


20.00 


20.00 


20.00 


20.40 


22.00 


22.00 


22 . 00 


22.00 


33 


44.70 


44.70 


44.70 


44.70 


44.70 


47.50 


45.50 


45.00 


45.50 


45.50 


34 


44.70 


44.70 


44.70 


44.70 


44 . 70 


45.50 


45.00 


45.00 


45.00 


45.00 


35 


23.00 


23.00 


23.00 


23.00 


23-00 


23.00 


23.00 


23.00 


23.00 


23.00 


36 


25.00 


31 .90 


31 .90 


31 .90 


31 .90 


31 .90 


31 .90 


31 .90 


31 .90 


31 .90 


37 


4.00 


3.00 


5.00 


5.00 


5.00 


2.80 


3.00 


3.00 


3.00 


3.00 


38 


3.00 


3.00 


3.00 


3.00 


3.00 


2.80 


3.00 


3.00 


3.00 


3.00 


39 


7.00 


8.00 


7.00 


10.00 


10.00 


8.40 


8.00 


9 . 00 


7.00 


8.00 


40 


7.00 


7.00 


6.00 


8.00 


7.00 


8.00 


7.00 


7.00 


7.00 


6.00 


41 


3.00 


4.00 


3.00 


1 .00 


3.00 


4.00 


3.00 


3 . 00 


5.00 


3.00 


42 


7.00 


10.00 


6-60 


6.60 


6.60 


5.00 


7.50 


4.00 


3.00 


4.00 


43 


.6.00 

*7 f"i/"l 


6.00 
£ on 


6.00 
6.00 


6.00 
6 . 00 


: 6.00 

6.00 


5.00 
8.00 


7.00 
6.00 


3.00 
6.00 


5.00 


5.00 
6.00 


44 


f . Uv 


D . UU 


6. 00 


45 


7.00 


7.00 


7.00 


6.00 


7.00 


6.00 


6.00 


7.00 


6.00 


6.00 


46 


10.00 


12.50 


10.00 


10.00 


5.00 


8.00 


10.00 


4.00 


10.00 


10.00 


47 


4.00 


5.00 


3.00 


5.10 


5.00 


5.00 


5.00 


4.00 


5.00 


4.00 


48 


19.00 


15.00 


25.00 


17.50 


19. 10 


16.00 


15.00 


25.00 


19. 10 


15.00 


49 


51 .00 


51 .00 


51 .00 


51 -00 


51 .00 


50.00 


50.00 


50.00 


51.00 


51.00 


50 



65 



1977 PREVAILING CHARGE SUMMARY DATA 



PAN-AMERICAN LIFE INSURANCE CO. 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTR0SECT10N OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



06 



30.00 

6.00 
12.80 



10.00 

20.00 

638.00 

638.00 

10.00 

15.00 

175.00 

35.00 

319.00 

750.00 

10.00 

750.00 

286.00 

25.00 

319.00 

450.00 

285.00 

40.00 

14.00 

638.00 

560.00 

540.00 

600.00 

15.00 

44.70 

20.00 

44.70 

44.70 

23.00 

25.00 

5.00 

3.00 

7.00 

5.00 

3.00 

6.00 

6.00 

7.00 

5.00 

6.00 

3.00 

17.00 

14.00 



07 



19.10 

8.00 
19.10 



10.00 

20.00 

638.00 

638.00 

15.00 

15.00 

175-00 

35.00 

3 1 9 . 00 

10.00 

10.00 

750.00 

286.00 

25.00 

3 1 9 . 00 

450.00 

285.00 

40.00 

14.00 

638.00 

560.00 

540.00 

600.00 

15.00 

44.70 

20.00 

44.70 

44.70 

23.00 

25.00 

4.00 

3.00 

8.00 

7.00 

5.00 

5.00 

5.00 

7.00 

5.00 

7.00 

4.00 

15.00 

51 .00 



50 



LOUISIANA 
LOCALITY DESIGNATION FOR SPECIALIST 

06 07 50 

25.00 



10.00 
15.00 



15.30 


30.00 


. 30.00 


6.40 


9.00 


10,20 


12.00 


15.00 


19.10 


10.00 


12.00 


15.00 


15.00 


25.00 


25.00 


638.00 


600.00 


600.00 


638.00 


630.00 


590.00 


12 .80 


1 6 . 50 


12.80 


14.50 


10.00 


10.00 


175.00 


150.00 


150.00 


31 .90 


50.00 


50.00 


3 1 9 . 00 


319.00 


319.00 


750.00 


750.00 


750.00 


10.00 


10.00 


10.00 


750.00 


750.00 


750.00 


286.00 


286.00 


286.00 


25.50 


25.00 


25.00 


3 1 9 . 00 


350.00 


350.00 


450.00 


400.00 


500.00 


285.00 


319.00 


300.00 


40.00 


40.00 


44.70 


10.00 


10.00 


10.00 


638.00 


600.00 


600.00 


560.00 


480.00 


550.00 


540.00 


525.00 


540.00 


600.00 


500.00 


500.00 


15.30 


19.10 


19.10 


44 . 70 


44.70 


44.70 


25.00 


22.00 


22.00 


40.00 


45.50 


4 5.50 


44.70 


45.00 


45.00 


23.00 


23.00 


23.00 


25.00 


31 .90 


31 .90 


3.00 


3.00 


2.00 


3-00 


3.00 


3.00 


8-00 


6.50 


7.50 


7-00 


7.00 


7.00 


3.00 


4.00 


3.00 


6.00 


3.50 


4.00 


6.00 


5.00 


5 . 00 


6.60 


6.00 


6.00 


7.00 


6.00 


6.00 


10.00 


6.00 


8.00 


4.00 


3.50 


4.00 


19.10 


15.00 


15.00 


51 .00 


51.00 


50.00 



15.00 

25.00 

600.00 

638.00 

15.00 

10.00 

150.00 

50.00 

319.00 

750.00 

10.00 

750.00 

286.00 

31 .90 

350.00 

446.00 

300.00 

45.00 

7.00 

600.00 

574.20 

540.00 

600.00 

10.00 

44.70 

22.00 

25.00 

25.00 

23.00 

31 .90 



00 
00 
00 



10.00 



00 
.00 



5.00 
7.00 
6.00 
7.00 
3.00 
15.00 
50.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



ee 



MAINE 



67 



MAINE 




Three Localities: 

01 - Northern Maine - Aroostook, Piscataquis, Penobscot, Washington, 

Hancock, Waldo, Somerset and Franklin Counties 

02 - Central Maine - Oxford, Androscoggin, K«flebeo, Sagadahoc, 

Lincoln, and Knox Counties gg 

03 - Southern Maine - Cumberland and York Counties 



1977 PREVAILING CHARGE SUMMARY DATA UNION MUTUAL LIFE INSURANCE CO. 



MAINE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



LOCALITY 


DESIGNATION FOR GENERAL 


PRACTICE 


LOCALITY 


DESIGNATION FOR 


SPECIALIST 




AREA 01 


AREA 02 


AREA 03 


AREA 01 


AREA 02 


AREA 03 




12.80 


10.00 


10-20 


12.80 


1 5 . 00 


1 5 . 00 


01 


31 .90 


25.00 


25.00 


31.90 


31 .90 


31 .90 


02 


5.00 


5.00 


6.40 


6.40 


5.10 


6.40 


03 


7.70 


8.00 


8.90 


10.00 


10.00 


1 . oo 


04 


12.00 


10.00 


12.00 


12.00 


15.00 


12.80 


05 


19.10 


19.10 


15.00 


25.00 


20.00 


22.00 


06 


25.00 


25.00 


25.00 


35.00 


35.00 


40.00 


07 


7.00 


8.00 


10.00 


10.00 


10.00 


10.00 


08 


24.00 


25.50 


20.00 


21 .00 


19. 10 


25.00 


09 


455.00* 


497.00* 


462.00* 


525.00 


. 430.00 


525.00 


10 


520.00* 


568.00* 


528-00* 


574.20 


574.20 


574.20 


11 


13.40 


18.00 


15.00 


25.00 


25.00 


25.00 


12 


15.00 


20.00 


15. 00 


18.75 


25.00 


1 5 . 00 


13 


97.50* 


106.50* 


99.00* 


1 12.50 


95.70 


114.80 


14 


19.10 


25.00 


1 5 . 00 


25.00 


35.00 


25.00 


15 


227.50* 


248.50* 


231 .00* 


180.00 


180.00 


180.00 


16 


650.00* 


710.00* 


660.00* 


660.00* 


660.00* 


660.00* 


17 


1 1 .50 


10.00 


10.00 


12.80 


13.00 


13.00 


18 


520.00* 


568.00* 


528.00* 


560.00 


540.00 


600.00 


19 


260-00* 


284.00* 


264.00* 


280.00 


255.20 


300.00 


20 


15.00 


22.00 


25.00 


20.30 


22.50 


20.00 


21 


195.00* 


213.00* 


198.00* 


1 9 1 . 4o 


191 .40 


225.00 


22 


390.00* 


426.00* 


396.00* 


420.00 


427.50 


450.00 


23 


245.00 


245.00 


245.00 


250.00 


252.00 


262.50 


24 


32.50* 


35.50* 


33.00* 


37.50 


37.50 


37.50 


25 


21 -00 


17.50 


20.00 


15.00 


15.00 


15.00 


26 


520.00* 


568.00* 


528.00* 


600.00 


600.00 


600.00 


27 


520.00* 


568.00* 


528.00* 


600.00 


600.00 


600.00 


28 


455.00* 


497.00* 


462.00* 


600.00 


600.00 


600.00 


29 


520.00* 


568.00* 


528.00* 


500.00 


500.00 


500.00 


30 


15.00 


14.00 


14.00 


5.00 


5.00 


5.00 


31 


21 .30* 


12.90* 


21 -00* 


6.00 


6.00 


6.00 


32 


17.75* 


10.75* 


17.50* 


6.00 


6.00 


6.00 


33 


42.60* 


25.80* 


42-00* 


20.00 


20.00 


20.00 


34 


S: 14.20* 


8.60* 


14.00* 


6.00 


6.00 


6.00 


35 


28.40* 


17.20* 


28.00* 


15.00 


15.00 


15.00 


36 


35.50* 


21 .50* 


35.00* 


17.00 


17.00 


17.00 


37 


2.00 


2.00 


2.00 


2.00 


3.00 


2.50 


38 


3.00 


3.00 


3.00 


3.00 


4.00 


1 .00 


39 


8.00 


9.00 


5.00 


1 . 00 


7.00 


6.00 


40 


6.00 


6 . 00 


5.00 


7.00 


5.00 


5.00 


41 


2.00 


3.00 


3.00 


2.00 


3.00 


2.00 


42 


6.00 


6.00 


5.00 


5.00 


3.00 


3.00 


43 


6.00 


5.00 


2.00 


5.00 


3.50 


3.00 


44 


6.00 


' 5.00 


5.00 


6.00 


5.00 


5.00 


45 


6.00 


6.50 


6.00 


7.00 


5.00 


5.00 


46 


5.00 


5.00 


7.00 


5.00 


5.00 


6.00 


47 


3.00 


3.00 


3.00 


3.00 


4.00 


3.00 


48 


25.00 


19.00 


18.00 


16.00 


17.00 


17.00 


49 


43.40* 


40.60* 


39.20* 


45.00 


45.00 


45.00 


50 






69 



MARYLAND 







Three Localities: (Exclusive of Washington D.C. Locality.) 

01 Baltimore City, Baltimore, Howard, Harford, Anne Arundel 
and Carroll Counties 






02 Frederick, Washington, Allegany and Garrett Counties 

03 Calvert, Charles, St. Mary's, Cecil, Kent, Queen Anne's, 
Caroline, Talbot, Dorchester, Wicoinico, Somerset and 
Worchester Counties 



70 



1977 PREVAILING CHARGE SUMMARY DATA B/C-B/S OF MARYLAND 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 






PROCEDURE DESCRIPTION ZONE 1 

01 INITIAL LIMITED OFFICE VISIT 8. 90 

02 INITIAL COMP OFFICE VISIT 31.90 

03 MINIMAL OFFICE VISIT 4.00 

04 ROUTINE BRIEF OFFICE VISIT 8.90 

05 ROUTINE BRIEF HOME VISIT 12.80 

06 INITIAL BRIEF HOSPITAL VISIT 12.80 

07 INITIAL COMP HOSPITAL VISIT 35.00 

08 ROUTINE BRIEF HOSPITAL VISIT 10.00 

09 BIOPSY SKIN 30.00 

10 RADICAL MASTECTOMY 600.00 

11 REDUCTION OF FRACTURE 638.20 

12 ARTHOTMY 15.00 

13 NEEDLE PUNCTURE OF BURSA 15-00 

14 BRONCHOSCOPY 127.60 

15 THORACENTESIS 40.00 

16 CATHFTERI7ATI0N 200.00 

17 INSERTION OF PACEMAKER 500.00 

18 BLOOD TRANFUSION 25.00 

19 COLECTOMY 658.20 

20 APPENDECTOMY 325.00 

21 SIGMOIDOSCOPY 30.00 

22 HEMORRHOIDECTOMY 250.00 

23 CHOLECYSTECTOMY 446.70 

24 REPAIR HERNIA 319.10 

25 CYSTOSCOPY 60.00 

26 DILATION OF URETHRA 20.00 

27 PROSTATECTOMY 702.00 

28 ELECTROSECTION OF PROSTATE 638.20 

29 HYSTERECTOMY 705.30 

30 EXTRACTION OF LENS 564.20 

31 X-RAY CHEST 15.30 

32 X-RAY SPINE 25.00 

33 X-RAY HIP 15.00 

34 X-RAY STOMACH 45.00 

35 X-RAY COLON 40.00 

36 COBALT 15.00 

37 RADIOTHERAPY 30.00 

38 HEMOGLOBIN 5.00 

39 WHITE CELL COUNT 2.00 

40 COMPLETE BLOOD COUNT 6.40 

41 CHOLESTERAL BLOOD COUNT 5.00 

42 HEMATOCRIT 3.00 

43 PROTHROMBIN 5 • 00 

44 SEDIMENTATION RATE .3.00 

45 BLOOD SUGAR 5-00 

46 BUN UREA NITRATE 5.00 

47 PAP TEST 5.00 

48 URINALYSIS 3 • 00 

49 ELECTROCARDIOGRAM 20.00 

50 ELECTROENCEPHALOGRAM 60.00 



ZONE 2 

9.00 
35.00 
7.00 
9.00 
12-80 
8.90 
30.00 
9.30 
30.00 
600.00 
638.20 
7.00 
15.00 
127.60 
40.00 
200.00 
500.00 
25.00 
658.20 
325.00 
30.00 
250.00 
446.70 
319.10 
60 . 00 
20.00 
702.00 
638.20 
705.30 
564.20 
15.30 
25.00 
20.00 
45.00 
40.00 
15.00 
30.00 
5.00 
3.00 
5.00 
5.00 
2.00 
5.00 
3 . 00 
5.00 
4.00 
7.00 
2.00 
20.00 
60.00 





MARYLAND 






ACTICE 


LOCALITY 


DESIGNATION FOR 


SPECIALIST 




ZONE 3 


ZONE 1 


ZONE 2 


ZONE 3 




8. 90 


12.00 


10.20 


10.20 


01 


6.00 


60.00 


55.00 


50.00 


02 


2.00 


5.00 


2.00 


4.00 


03 


8.00 


12.00 


10.00 


1 2 . 00 


04 


12.80 


19.20 


18.60 


15.00 


05 


10.00 


12.80 


12.80 


10.00 


06 


31 .90 


60.00 


50.00 


50.00 


07 


7.70 


12.80 


10.00 


12.00 


08 


30.00 


30.00 


35.00 


20.00 


09 


600.00 


600.00 


600.00 


500.00 


10 


638.20 


638.20 


638.20 


638.20 


11 


20.00 


28.00 


20.00 


25.50 


12 


19.20 


30.00 


25.00 


20.00 


13 


127-60 


127.60 


105.00 


127.60 


14 


40.00 


63.80 


30.00 


50.00 


15 


200.00 


1 9 1 . 50 


223.40 


150.00 


16 


500.00 


600.00 


400.00 


400.00 


17 


25-00 


28.10 


28. 10 


28. 1T 


18 


658.20 


638.20 


575.00 


638.20 


19 


325.00 


319.10 


250.00 


325.00 


20 


25.00 


35.00 


27.00 


25.50 


21 


250.00 


250.00 


250.00 


250.00 


22 


446.70 


450.00 


400.00 


446.70 


23 


319. lO 


319.10 


255.30 


275.70 


24 


60 .00 


60.00 


42.25 


63.00 


25 


20.00 


20.00 


18.00 


25.00 


26 


702.00 


702.00 


702.00 


702.00 


27 


638.20 


638.20 


450.00 


638.20 


28 


705.30 


638.20 


500.00 


574.40 


29 


564.20 


638.20 


475.00 


510:60 


30 


18.00 


19.20 


6.00 


1 7 . 00 


31 


25-00 


31 .90 


30.00 


30-00 


32 


20.00 


25.00 


20.00 


16.50 


33 


45.00 


55.00 


25.00 


23.00 


34 


40.00 


50.00 


18.00 


22.00 


35 


15.00 


20.00 


10.00 


15.00 


36 


30.00 


30.00 


30.00 


30.00 


37 


5.00 


5.00 


5.00 


5.00 


38 


3.00 


3.20 


3.00 


3.00 


39 


6 . 40 


6.00 


8.00 


5 . 50 


40 


6.00 


5.00 


5.00 


6.00 


41 


3.00 


3.00 


3.00 


3.00 


42 


5-00 


5.00 


3.00 


3.00 


43 


3-00 


4.00 


5.00 


2.00 


44 


5.00 


5.00 


5.00 


5.00 


45 


5.00 


5.00 


7.00 


5.00 


46 


13.00 


5.00 


5.00 


6.00 


47 


3.00 


4.00 


3.00 


3.00 


48 


20.00 


20.00 


20.00 


20.00 


49 


60.00 


63.80 


63.80 


55.00 


50 






71 



MASSACHUSETTS 



DETAIL _W_«OST<HI »«CA 




Two Localities: 

01 - Urban 

02 - Suburban/Rural 

(For more locality information 
see Appendix A) 



V*Jv 



<J_ NANTUCKET ) 



72 



1977 PREVAILING CHARGE SUMMARY DATA B/S OF MASSACHUSETTS 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 



URBAN 



SUBURB 



06 
07 
08 



01 INITIAL LIM 

02 INITIAL COM 

03 MINIMAL OFF 

04 ROUTINE BR I 

05 ROUTINE BR I 
INITIAL BR I 
INITIAL COM 
ROUTINE BRI 

09 BIOPSY SKIN 

10 RADICAL MAS 

11 REDUCTION 

12 ARTHOTMY 

13 NEEDLE PUNC 

14 BRONCHOSCOP 

15 THORACENTES 

16 CATHETERIZA 

17 INSERTION 

18 BLOOD TRANF 

19 COLECTOMY 

20 APPENDECTOM 

21 SIGMOIDOSCO 

22 HEMORRHOIDE 

23 CHOLECYSTEC 

24 REPAIR HERN 

25 CYSTOSCOPY 

26 DILATION OF 

27 PROSTATECTO 

28 ELECTROSECT 

29 HYSTERECTOM 

30 EXTRACTION 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMA 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAP 

38 HEMOGLOBIN 

39 WHITE CELL 

40 COMPLETE BL 

41 CHOLESTERAL 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATI 

45 BLOOD SUGAR 

46 BUN UREA NI 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARD 

50 ELECTROENCE 



ITED OFFICE VISIT 
P OFFICE VISIT 
ICE VISIT 
EF OFFICE VISIT 
EF HOME VISIT 
EF HOSPITAL VISIT 
P HOSPITAL VISIT 
EF HOSPITAL VISIT 

TECTOMY 

F FRACTURE 

TURE OF BURSA 

Y 

IS 

TION 

F PACEMAKER 

US I ON 

Y 

PY 

CTOMY 

TOMY 

IA 

URETHRA 
MY 

ION OF PROSTATE 
Y 
OF LENS 











20.00 


15.00 




15.00 


1 5 . 00 




10-00 


1 . 00 




15.00 


1 2 . 80 




19.10 


20 . 00 




10.00 


10.00 




25.00 


25.50 




25.00 


20.00 




25.00 


20.00 



CH 



COUNT 
OOD COUNT 
BLOOD COUNT 



ON RATE 
TRATE 



IOGRAM 
PHALOGRAM 



50.00 



275.00 
31 .90 
255.00 
475. CO 
250.00 

15.00 



550.00 

19. 10 
15.00 
19.10 



3.00 
3.00 
6.00 
5.00 
3.00 
6.00 



00 
00 

00 



8.00 

3.00 

20.00 



30.00 



20.00 

223.30 
25.00 
210.15 
382.80 
223.80 

15.00 



400 . 00 

19.10 
15.00 
19.10 



3.00 
3.50 
6.00 
5.00 
3.00 
6.00 
4.00 
5.00 
5.00 
6.00 
3.00 
25.00 



MASSACHUSETTS 
LOCALITY DESIGNATION 
URBAN 



31.90 
25. 15 
15.00 
19.10 

31 .90 

15.00 

30.00 

600.00 

750-00 

25.00 

25.00 

127.60 

44.70 

240.00 

850. 00 

30. 00 

650.00 

3 1 9 . 00 

30.00 

250.00 

510.00 

300.00 

60.00 

25.00 

701 .80 

638.00 

550.00 

638.00 

19.10 

25.00 

19. 10 

50.00 

45.90 

25.00 

26.20 

3.00 

3.00 

7.00 

6.00 

3.00 

6.00 

5.00 

5.00 

5.00 

10.00 

4.00 

20.00 

45.00 



FOR SPECIALIST 
SUBURB 



31 .90 
20.00 
12.00 
15.00 

31 .90 

12.80 

20.00 

574.20 

640.00 

25.00 

30.00 

159.50 

44.70 

199.00 

720.00 

11 .00 

600.00 

319.00 

30.00 

250.00 

478.50 

287. 10 

50.00 

15.00 

574.20 

510.40 

550.00 

600.00 

18.00 

25.00 

21 .50 

48.50 

44.70 

23.00 

27.00 

3.00 

3.00 

7.80 

6.00 

3.00 

5.00 

4.00 

5.00 

5.00 

7.50 

4.00 

20.00 

45.00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



73 



MICHIGAN 




Three Localities: 

1 - Metropolitan-Kacomb, Oakland, 

Washtenaw, Wayne 

2 - Urban-Arenac, Bay, Calhoun, Emmett, 

Genesee, Gladwin, Grand Traverse 
Ingham, Iosco, Isabella, 
Jackson, Kalamazoo, Kent, 
Lapeer, Livingston, Mecosta, 
Midland, Monroe, Muskegon, 
Saginaw, St. Clair 

3 - Itural-ftest of the State 



7h 



1977 PREVAILING CHARGE SUMMARY DATA B/C-B/S OF MICHIGAN 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



MICHIGAN 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



PROCEDURE DESCRIPTION 

INITIAL LIMITED OFFICE VISIT 
INITIAL COMP OFFICE VISIT 
MINIMAL OFFICE VISIT 
ROUTINE BRIEF OFFICE VISIT 
ROUTINE BRIEF HOME VISIT 
INITIAL BRIEF HOSPITAL VISIT 
INITIAL COMP HOSPITAL VISIT 
ROUTINE BRIEF HOSPITAL VISIT 
BIOPSY SKIN 

TECTOMY 

F FRACTURE 

TURE OF BURSA 

Y 

IS 

TION 

F PACEMAKER 

USION 

Y 

PY 

CTOMY 

TOMY 

IA 

URETHRA 
MY 

ION OF PROSTATE 
Y 
OF LENS 



RADICAL MAS 

REDUCTION 

ARTHOTMY 

NEEDLE PUNC 

BRONCHOSCOP 

THORACENTES 

CATHETEPIZA 

INSERTION 

BLOOD TRANF 

COLECTOMY 

APPENDECTOM 

SIGMOIDOSCO 

HEMORRHOIDE 

CHOLECYSTEC 

REPAIR HERN 

CYSTOSCOPY 

DILATION OF 

PROSTATECTO 

ELECTROSECT 

HYSTERECTOM 

EXTRACTION 

X-RAY CHEST 



SPINE 
HIP 
STOMA 
COLON 



X-RAY 

X-RAY 

X-RAY 

X-RAY 

COBALT 

RADIOTHERAP 

HEMOGLOBIN 

WHITE CELL 

COMPLETE BL 

CHOLESTERAL 

HEMATOCRIT 

PROTHROMBIN 

SEDIMENTATI 

BLOOD SUGAR 

BUN UREA NI 

PAP TEST 

URINALYSIS 

ELECTROCARD 

ELECTROENCE 



CH 



COUNT 
OOD COUNT 
BLOOD COUNT 



ON RATE 
TRATE 



IOGRAM 
PHALOGRAM 



1 

16.60 
30.00 
10.00 
10.00 
19.10 
31 .90 
31 .90 
12.30 
40.00 
638.00 

31.90 

31 .90 

150.00 

31 .90 

40.00 

750.00 

30.00 

750.00 

250.00 

25.50 

300.00 

500.00 

250.00 

50.00 

19.10 

550.00 

560.00 

650.00 

575.00 

12.00 

18.00 

17.00 

43.00 

43.00 

15.00 

15.00 

3.00 

3.00 

6.00 

5.00 

3.00 

5.00 

3.00 

4.00 

4.00 

5.00 

3.00 

19.10 

35.00 



3 



. 



15.00 

25.00 

8. SO 

8.90 

12.80 

31 .90 

31 .90 

10.00 

25.50 

500.00 

30.00 
25.50 

134.00 

35.00 

400.00 

750.00 

30.00 

6 1 6 . 00 

245.00 

28.70 

250.00 

400.00 

250.00 

75.00 

22.30 

500.00 

480.00 

500.00 

500.00 

12.00 

18.00 

17.00 

43.00 

35.00 

15.00 

15.00 

3.00 

3.00 

6.00 

5.00 

3.00 

5.00 

3.00 

4.00 

4.00 



00 
00 



19.10 
45.00 



10.00 


25.00 


15.00 


48.00 


7.70 


12.80 


7.70 


12.80 


12.80 


19.10 


31 .90 


50.00 


31 .90 


50.00 


9.40 


14.00 


30.00 


30.00 


510.40 


638.00 


20-00 


31.90 


22.30 


25.50 


125.00 


150.00 


30 . 00 


38.30 


350.00 


400.00 


600.00 


750.00 


30.00 


23.00 


525.00 


638.00 


245-00 


300.00 


25-00 


28.00 


225.00 


300.00 


375.00 


500.00 


223.30 


250.00 


50.00 


75.00 


15.00 


19. 10 


500.00 


550.00 


500-00 


560.00 


500.00 


650.00 


525.00 :, 


575.00 


12.00 


■':■ 12.00 


18.00 


1 8 . 00 


17.00 


1 7 . 00 


40.00 


43.00 


40 . 00 


43.00 


15.00 


15.00 


15.00 


15.00 


3.00 


3.00 


3.00 


3.00 


6.00 


6.00 


5-00 


5.00 


3.00 


3.00 


5.00 


5.00 


3.00 


3.00 


4-00 


4.00 


4.00 


4.00 


5.00 


5.00 


3.00 


3.00 


19. iO 


19.10 


35.00 


44.70 



-. • » . 



ION FOR 


SPECIALIST 




2 


3 




25.00 


20.00 


01 


40.00 


30.00 


02 


10.20 


8.90 


03 


10.20 


8.90 


04 


1 5 . 00 


12.80 


05 


50.00 


42.00 


06 


50.00 


42.00 


07 


12.00 


1 1 .90 


08 


30.00 


25.50 


09 


500.00 


510.40 


10 
11 


28.70 


25.50 


12 


28.70 


22.50 


13 


134.00 


125.00 


14 


31.90 


25.00 


15 


400.00 


350.00 


16 


750.00 


600.00 


17 


25.00 


30.00 


18 


612.50 


525.00 


19 


250.00 


250.00 


20 


25-00 


25.00 


21 


250.00 


225.00 


22 


420.00 


400.00 


23 


250.00 


229.70 


24 


60.00 


65.00 


25 


19. 10 


19.00 


26 


500.00 


500.00 


27 


480.00 


500.00 


28 


500.00 


487.50 


29 


500.00 


5 1 . 40 


30 


10.00 


10.00 


31 


16.00 


18.00 


32 


1 7 . 00 


1 5 . 00 


33 


40.00 


38.30 


34 


4 3.00 


40.00 


35 


15.00 


15.00 


36 


15.00 


15.00 


37 


3.00 


3.00 


38 


3.00 


3.00 


39 


6.00 


6.00 


40 


5.00 


5.00 


41 


3.00 


3.00 


42 


5.00 


5.00 


43 


3.00 


3.00 


44 


4.00 


4.00 


45 


4.00 


4.00 


46 


5.00 


5.00 


47 


3.00 


3.00 


48 


19.10 


19. 10 


49 


44.70 


35.00 


50 



75 



MINNESOTA 










Travelers 

Dl - 'Anoka, Dakota, FiLnore, Goodhue, Hennepin, Houston, Olmstead, 
Ramsey, Wabasha,- Washington, and Winona Counties 

Blue Shield of Minnesota 

X)2 - Big Stone, Stevens, Pope, Stearns, Wright, Sherburno, Isanti, 
and Chisago Counties and all points North 

Ol; - Rest of State (also excluding Travelers' localities) 



76 



1977 PREVAILING CHARGE SUMMARY DATA THE TRAVELERS INSURANCE COMPANY 

LOCALITY DESIGNATION FqR GENERAL PRACTICE 



MINNESOTA 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 



AREA 1 



01 INITIAL LIMITED OFFICE VISIT 


12.80 


02 INITIAL COMP OFFICE VISIT 


25.00 


03 MINIMAL OFFICE VISIT 


8.90 


04 ROUTINE BRIEF OFFICE VISIT 


8.90 


05 ROUTINE BRIEF HOME VISIT 


15.00 


06 INITIAL BRIEF HOSPITAL VISIT 


23.00 


07 INITIAL COMP HOSPITAL VISIT 


35.00 


08 ROUTINE BRIEF HOSPITAL VISIT 


8.90 


09 BIOPSY SKIN 


25.00 


10 RADICAL MASTECTOMY 


600.00 


11 REDUCTION OF FRACTURE 


638.00 


12 ARTHOTMY 


12.50 


13 NEEDLE PUNCTURE OF BURSA 


12.50 


14 BRONCHOSCOPY 


127.60 


15 THORACENTESIS 


30.00 


16 CATHETERIZATION 


200.00 


17 INSERTION OF PACEMAKER 


638.00 


18 BLOOD TRANFUSION 


10.60 


19 COLECTOMY 


700.00 


20 APPENDECTOMY 


319-00 


21 SIGMOIDOSCOPY 


20 . CO 


22 HEMORRHOIDECTOMY 


293.50 


23 CHOLECYSTECTOMY 


446.60 


24 REPAIR HERNIA 


255.20 


25 CYSTOSCOPY 


37.50 


26 DILATION OF URETHRA 


12.80 


27 PROSTATECTOMY 


680.00 


28 ELECTROSECTION OF PROSTATE 


620.00 


29 HYSTERECTOMY 


574.20 


30 EXTRACTION OF LENS 


, 550.00 


31 X-RAY CHEST 


14-00 


32 X-RAY SPINE 


25.00 


33 X-RAY HIP 


24.00 


34 X-RAY STOMACH 


40 . 60 




38.30 


36 COBALT 


18.00 


37 RADIOTHERAPY 


18.50 


38 HEMOGLOBIN 


3.00 


39 WHITE CELL COUNT 


4.00 


40 COMPLETE BLOOD COUNT 


12.00 


41 CHOLESTERAL BLOOD COUNT 


7.00 


42 HEMATOCRIT 


3.60 


43 PROTHROMBIN 


5-55 


44 SEDIMENTATION RATE 


5-00 


45 BLOOD SUGAR 


7.50 


46 BUN UREA NITRATE 


7.50 


47 PAP TEST 


10.00 


48 URINALYSIS 


4.00 


49 ELECTROCARDIOGRAM 


18.00 


50 ELECTROENCEPHALOGRAM 


50.00 



:■ SSSHSk- : 





AREA 1 








15.00 




50.00 




10.00 




10.00 




19.10 




31 .90 




50.00 




12.00 




25.00 




574.20 




638.00 




15.00 




15.00 




153. 10 




30.00 




191 .40 




638.00 




16.40 




700.00 




3 1 9 . 00 




25.50 




293.50 




459.40 




3 1 9 . 00 




37.50 




1 1 .00 




612.50 




574.20 




574.20 




550.00 




1 3 . 50 




24.00 




17.00 




38.30 




33.30 




20.00 




18.50 




3.50 




4.00 




12.00 




7.00 




4.00 




5 . 00 




4.00 




7.00 




7.50 




10.00 




5.00 




18.00 




50.00 












01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
1 1 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 



28 
29 
30 
31 
32 
33 
34 
35 

37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



77 



1977 PREVAILING CHARGE SUMMARY DATA 



B/C-B/S OF MINNESOTA 



PROCEDURE DESCRIPTION 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
1 1 
12 



INITIAL 
INITIAL 
MINIMAL 
ROUTINE 
ROUTINE 
INITIAL 
INITIAL 
ROUTINE 



LIMITED OFFICE VISIT 
COMP OFFICE VISIT 
OFFICE VISIT 
BRIEF OFFICE VISIT 

HOME VISIT 

HOSPITAL VISIT 

HOSPITAL 

HOSPITAL 



BRIEF 

BRIEF 

COMP 

BRIEF 
BIOPSY SKIN 
RADICAL MASTECTOMY 
REDUCTION OF FRACTURE 
_ ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 
THORACENTESIS 
CATHETERIZATION 
INSERTION OF PACEMAKER 
BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 
SIGMOIDOSCOPY 
HEMORRHOIDECTOMY 
CHOLECYSTECTOMY 
REPAIR HERNIA 
CYSTOSCOPY 
DILATION OF URETHRA 
PROSTATECTOMY 
ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 
X-RAY CHEST 
X-RAY SPINE 
X-RAY HIP 
X-RAY STOMACH 
X-RAY COLON 
COBALT 

RADIOTHERAPY 
HEMOGLOBIN 
WHITE CELL COUNT 
COMPLETE BLOOD COUNT 
CHOLESTERAL BLOOD COUNT 
HEMATOCRIT 
PROTHROMBIN 
SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 
PAP TEST 
URINALYSIS 
ELECTROCARDIOGRAM 



VISIT 
VISIT 



15 
16 
17 
18 



21 
22 
23 
24 
25 
26 
27 
28 



31 

32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 



47 

48 
49 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 
04 02 



10.00 

30.00 

6.00 

7. 10 

10.00 

19.10 

36.00 

7.10 

19. 10 

504 . 00 

612.50 

15.00 

15.00 

1 1 5 . 00 

25.00 

340 . 00 

700.00 

36.00* 



50 ELECTROENCEPHALOGRAM 



9 


.00 


25 


.00 


5 


.50 


7 


.50 


10 


.00 


25 


.00 


40 


.00 


7 


.70 


25 


.00 


535 


.90 


612 


.50 


15 


.00 


15 


.00 


121 


.20 


25 


.00 


340 


.00 


725 


.00 


33 


.60 


612 


00 


275 


00 


19 


10 


229 


70 


375 


CO 


255 


20 


40 


20 


15 


00 


612 


50 


612 


00 


562 


70 


5i0 


40 


15 


00 


25 


00 


20 


00 


39 


00 


35 


00 


12 


50 


18. 


90 


3. 


00 


3. 


00 


8. 


75 


7. 


00 


3. 


00 


7. 


00 


4. 


40 


6. 


50 


6. 


00 


10. 


00 


4 . 


00 


18. 


00 


50. 


00 



612.00 

270.00 

19. 10 

240 . 00 

459.40 

255.20 

40.20 

18.00 

612.50 

612.00 

560.00 

640 . 00 

14.00 

25.00 

23.00 

38.30 

35.00 

12.50 

20.00 

3.00 

3.50 

10.00 

6.50 

3.00 

5.00 

4.00 

6 . 00 

6.00 

12.00 

3.50 

19. 10 

46.20 



MINNESOTA 
LOCALITY DESIGNATION FOR SPECIALIST 
04 02 



10-00 

49.50 

6.00 

7.70 

15.00 

30.00 

49.50 

8. 90 

24.40 

417.00 

612.50 

12.80 

15.00 

127.60 

21 .00 

340.00 

725.00 

36.00* 

510.40 

200.00 

19. 10 

229.70 

446.60 

268.00 

40.30 

11 .60 

612.50 

550.00 

510.40 



510.40 

5 . 00 

9.00 

8. 70 

18.00 

18.00 

15.00 

12.00 

3.60 

3.60 

8.75 

6.00 

3.50 

5.00 

4.20 

6.00 

5.00 

10.00 

4.00 

17.00 

50.00 



10.00 


01 


38.30 


02 


5.40 


03 


8.90 


04 


10.00 


05 


21 .00 


06 


45.00 


07 


8.90 


08 


24.40 


09 


476.40 10 


627.20 


11 


12.80 


12 


15.00 


13 


127.60 


14 


21 .00 


15 


340.00 


16 


700.00 


17 


36.00* 


18 


612.50 


19 


321 .60 


20 


21 .00 


21 


229. 70 


22 


450.00 


23 


287.10 


24 


38.30 


25 


16.50 


26 


612.50 


27 


620.00 


28 


510.40 


29 


510.40 


30 


5.00 


31 


9.00 


32 


8.70 


33 


18.00 


34 


18.00 


35 


15.00 


36 


12.00 


37 


3.00 


38 


3.00 


39 


9.75 


40 


6 - 00 


41 


4.00 


42 


4.50 


43 


4.00 


44 


6.00 


45 


7.00 


46 


10.00 


47 


3.75 


48 


17.00 


49 


46.20 


50 



78 






MISSISSIPPI 



79 



MISSISSIPPI 




Two Localities: 

01 - Rural 

02 - Metropolitan 

(For more locality information 
see Appendix A) 

oO 



1977 PREVAILING CHARGE SUMMARY DATA THE TRAVELERS INSURANCE COMPANY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 
PROCEDURE DESCRIPTION AREA 1 AREA 2 



MISSISSIPPI 
LOCALITY DESIGNATION FOR SPECIALIST 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
1 1 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



INITIAL LIMITED OFFICE VISIT 

INITIAL COMP OFFICE VISIT 

MINIMAL OFFICE VISIT 

ROUTINE BRIEF OFFICE VISIT 

ROUTINE BRIEF HOME VISIT 

INITIAL BRIEF HOSPITAL VISIT 

INITIAL COMP HOSPITAL VISIT 

ROUTINE BRIEF HOSPITAL VISIT 

BIOPSY SKIN 

RADICAL MASTECTOMY 

REDUCTION OF FRACTURE 

ARTHOTMY 

NEEDLE PUNCTURE OF BURSA 

BRONCHOSCOPY 

THORACENTESIS 

CATHETERIZATION 

INSERTION OF PACEMAKER 

BLOOD TRANFUSION 

COLECTOMY 

APPENDECTOMY 

SIGMOIDOSCOPY 

HEMORRHOIDECTOMY 

CHOLECYSTECTOMY 

REPAIR HERNIA 

CYSTOSCOPY 

DILATION OF URETHRA 

PROSTATECTOMY 

ELECTROSECTION OF PROSTATE 

HYSTERECTOMY 

EXTRACTION OF LENS 

X-RAY CHEST 

X-RAY SPINE 

X-RAY HIP 

X-RAY STOMACH 

X-RAY COLON 

COBALT 

RADIOTHERAPY 

HEMOGLOBIN 

WHITE CELL COUNT 

COMPLETE BLOOD COUNT 

CHOLESTERAL BLOOD COUNT 

HEMATOCRIT 

PROTHROMBIN 

SEDIMENTATION RATE 

BLOOD SUGAR 

BUN UREA NITRATE 

PAP TEST 

URINALYSIS 

ELECTROCARDIOGRAM 

ELECTROENCEPHALOGRAM 



10.00 

12.80 

4.00 

6.40 

12.00 

19.10 

19.10 

6.00 

15.00 

535.90 

500 . 00 

10.00 

10.00 

114.80 

25.00 

250.00 

638.00 

25.00 

564.20 

310.40 

20.00 

255.20 

382.80 

200.00 

31 .90 

10.00 

400.00 

510.40 

500.00 

500.00 

12.80 

25.00 

19.10 

30.00 

38.00 

25.00 

15.00 

3.00 

3.00 



00 
00 
00 
00 
00 
00 



10.00 

25.00 

4.00 

7.70 

15.00 

25.00 

25.00 

5.00 

15.00 

535.90 

500.00 

10.00 

10.00 

1 1 4 . 80 

25.00 

250.00 

638.00 

15.00 

564.20 

310.40 

25.00 

255.20 

382 . 80 

210.00 

31 .90 

10.00 

400 . 00 

510.40 

500 . 00 

500 . 00 

15.00 

20.00 

19. 10 

30.00 

38.00 

25.00 

15.00 

3.00 



6.00 
12.50 

3.00 
15.00 
50.00 



00 

oo 
oo 
oo 
oo 

00 
00 
00 

50 
00 






18.50 
50.00 





AREA 1 


AREA 2 




10.00 


12.00 




25.50 


35.00 




5.00 


6.00 




8.00 


10.00 




12.00 


15.00 




25.00 


31 .90 




25.00 


31 .90 




6.00 


8.00 




19. 10 


19. 10 




526.60 


517.10 




574.20 


612.50 




11.00 


12.80 




11.00 


12.80 




H4.80 


141.00 


%•:*;*>:'■: : : 


25.00 


25.00 




250.00 


250.00 




638.00 


638.00 




12.80 


12.80 




557.40 


564.20 




297 . 30 


331 .60 




19.10 


25.00 




225.00 


258.60 




435.00 


450.00 




255.20 


300.00 




30.00 


31 .90 




12.80 


11 .00 




510.40 


510.40 




510.40 


510.40 




540.00 


500.00 


■' ' : . 


500.00 


510.40 




13.00 


15.00 




18.00 


20.00 




18.00 


19.00 




38.30 


40.00 




38.30 


40.00 




25.00 


18.20 




25.00 


25.00 




3.00 


3.00 




2.00 


3.00 


: ■; 


7.00 


10.00 




7.00 


6.00 




3.00 


3.00 




6.00 


6.00 




4.00 


3.00 




6.00 


6.00 




6.00 


5.00 




10.00 


5.00 




3.00 


5.00 




17.50 


19.10 




50.00 


50.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



81 



MISSOURI 



Kirksville ©ju 

-Hannibal o% 



01 

ox 




'oplar Bluff 02, 



Seven Localities: 

01, 02, 03 - General American Life 

I, II, III, VI - Blue Shield of Kansas City - Missouri 

(For more locality information see Appendix A) 



82 



1977 PREVAILING CHARGE SUMMARY DATA 



GENERAL AMERICAN LIFE INSURANCE 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



MISSOURI 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT , 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



AREA 1 


AREA 2 


15.00 


15.00 


20.00 


20.00 


3.00 


3.00 


8.90 


8.00 


15.00 


12.80 


25.00 


27.40 


25.00 


35.00 


10.00 


10.00 


20.00 


20.00 


600.00 


600.00 


600.00 


600. CO 


1 5 . 00 


8. 10 


8.00 


8.00 


120.00 


120.00 


31 .90 


31 .90 


275.00 


275.00 


625.00 


625.00 


14.60* 


14.60 


600.00 


600.00 


275.00 


275.00 


35.00 


19.90 


260.00 


260.00 


500.00 


400.00 


300.00 


275.00 


35.00 


35.00 


10.00 


10.00 


600.00 


600.00 


550.00 


550.00 


500.00 


500.00 


650.00 


650.00 


15.00 


15.00 


20.00 


19.25 


36.00 


36.00 


38.00 


38.30 


38.00 38.00 


25.00 


25.00 


20.00 


20.00 


3.00 


3.00 


3.00 


2.50 


9.00 


6.00 


6.00 


5.00 


3-00 


3-00 


6.00 


6.00 


5.00 


5.50 


6 . 00 6 . 00 


5.00 


5.50 


15.00 


11 .00 


3.00 


3.00 


17.00 


17.00 


42.50 


42-50 



AREA 3 


AREA 1 


AREA 2 


AREA 3 




8.00 


24.00 


25.00 


10.00 


01 


20.00 


51.10 


35.00 


50.00 


02 


2.90 


4.00 


3.80 


2.00 


03 


6.40 


11.50 


10.00 


8.00 


04 


12.00 


18.00 


13.90 


14.70 


05 


25.00 


33.50 


30.00 


25.00 


06 


35.00 


60.00 


40.00 


50.00 


07 


8.20 


12.00 


10.20 


10.00 


08 


25.00 


16.70 


25.00 


25.00 


09 


600.00 


644 . 40 


5 1 3 . 00 


600.00 


10 


501 -40 


635.00 


618.30 


700.00 


1 1 


1 . 00 


10.00 


18.00 


10.00 


12 


8.00 


18.00 


18.00 


18.00 


13 


120.00 : 


95.70 


120.00 


125.00 


14 


25.00 


35.00 


35.00 


35 00 


15 


275.00 


250.00 


250.00 


250.00 


16 


625.00 


625.00 


625.00 


625.00 


17 


14.60* 


15.60* 


14.60* 


14.60* 


18 


600.00 


652.70 


540.00 


640.00 


19 


275.00 


275.00 


275.00 


275.00 


20 


25.00 


3 1 . 90 


25.00 


25.00 


21 


260.00 ; 


255.30 


192.50 


300.00 


22 


1 1 . 00 


480.00 


444. 10 


430.00 


23 


266.20 


300.00 


269.50 


273.80 


24 


35.00 


35.00 


<->£» nn 


35.00 


25 


10.00 


15.00 


12.80 


1 5.00 


26 


600.00 


600.00 


480.00 


600.00 


27 


550.00 


550.00 


510.60 


550.00 


28 


500.00 


550.00 


478.70 


500.00 


29 


650-00 


649.20 


500.00 


550.00 


30 


14.90 


20.00 


12.50 


20.00 


31 


20.00 


30.40 


22.00 


27.50 


32 


25-00 


21.00 


21 .00 


21 .00 


33 


35-00 


55.90 


35.00 


49.00 


34 


35.00 


49.60 


34.00 


46.50 


35 


25.00 


25.00 


10.00 


20.00 


36 


20.00 


25.00 


12.00 


20.00 


37 


3.00 


3.00 


2.00 


3.25 


38 


3.00 


3.00 


2.50 


3.00 


39 


6.00 


7.00 


8.00 


5.00 


40 


6.00 


5.00 


6.00 


5.00 


41 


3.00 


3.00 


3.00 


2.50 


42 


5.00 


5.00 


5.00 


4.50 


43 


5.00 


5.00 


3.00 


5.00 


44 


5.00 


5.00 


6.00 


5.00 


45 


5.00 


5.00 


6.00 


5.00 


46 


10.00 


7.00 


10.00 


10.00 


47 


3.00 


4.00 


4.00 


3.00 


48 


15-00 


17.50 


17.00 


17.00 


49 


42.50 


45.00 


40.00 


40.00 


50 






83 



1977 PREVAILING CHARGE SUMMARY DATA 



B/S OF KANSAS CI TY . MISSOURI 



PROCEDURE DESCRIPTION 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

1 1 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 
AREA 01 AREA 02 AREA 03 AREA 06 



MISSOURI 
LOCALITY DESIGNATION FOR SPECIALIST 
AREA 01 AREA 02 AREA 03 AREA 06 



INITIAL 
INITIAL 
MINIMAL 
ROUTINE 
ROUTINE 
INITIAL 
INITIAL 
ROUTINE 
BIOPSY 



LIMITED OFFICE VISIT 
COMP OFFICE VISIT 
OFFICE VISIT 
BRIEF OFFICE VISIT 

HOME VISIT 

HOSPITAL VISIT 

HOSPITAL 

HOSPITAL 



BRIEF 
BRIEF 
COMP 
BR I EF 
SKIN 



VISIT 
VISIT 



RADICAL MASTECTOMY 

REDUCTION OF FRACTURE 

ARTHOTMY 

NEEDLE PUNCTURE OF BURSA 

BRONCHOSCOPY 

THORACENTESIS 

CATHETERIZATION 

INSERTION OF PACEMAKER 

BLOOD T RAN FUSION 

COLECTOMY 

APPENDECTOMY 

SIGMOIDOSCOPY 

HEMORRHOIDECTOMY 

CHOLECYSTECTOMY 

REPAIR HERNIA 

CYSTOSCOPY 

DILATION OF URETHRA 

PROSTATECTOMY 

ELECTROSECTION OF PROSTATE 

HYSTERECTOMY 

EXTRACTION OF LENS 

X-RAY CHEST 

X-RAY SPINE 

X-RAY HIP 

X-RAY STOMACH 

X-RAY COLON 

COBALT 

RADIOTHERAPY 

HEMOGLOBIN 

WHITE CELL COUNT 

COMPLETE BLOOD COUNT 

CHOLESTERAL BLOOD COUNT 

HEMATOCRIT 

PROTHROMBIN 

SEDIMENTATION RATE 

BLOOD SUGAR 

BUN UREA NITRATE 

PAP TEST 

URINALYSIS 

ELECTROCARDIOGRAM 

ELECTROENCEPHALOGRAM 



25.00 

25.00 

5.00 

8.00 

16.00 

25.00 

25.00 

10.00 

35.00 

615.00 

285.00* 

27.50 

12.50 

135.00 

25.00 

175.00 

600.00 

26.00* 

627.00* 

350.00 

25.00 

285.00 

500.00 

200.00 

65.00 

25.00 

685.00 

560.00 

575.00 

550.00 

25.00 

25.00 

15.00 

45.00 

40.00 



3.0U 
4.00 
7.50 
8.00 
3.00 
5.50 
5.00 
6.50 
6.00 
8.00 
2.75 
15.00 
50.00 



20 
20 

4 
10 
10 
25 
35 
10 
35 

615 

415 
20 
12 

135 
25. 

175. 

600. 
32. 

913. 

350. 
20. 

285. 

500. 

250. 
65. 
23. 

685. 

560. 

575. 

550. 
15. 
22. 
12. 
45. 
40. 



.00 

.00 

.00 

.00 

.00 

.00 

.00 

.00 

.00 

.00 

.00* 

.00 

.50 

.00 

.00 

.00 

.00 

.00* 

.00* 

.00 

.00 

.00 

.CO 

.00 

.00 

.00 

.00 

.00 

.00 

.00 

00 

00 

50 

00 

00 



00 
00 



10.00 
6.00 
3.00 
5.00 
4.50 
6.00 



35 

35 
3 

10 

12 

35. 

45. 

15. 

35. 
615. 
375. 

20. 

20. 
135. 

25. 
175. 
600. 

29. 
825. 
350. 

25. 
285. 
500. 
250. 

65. 

23. 
685. 
560. 
575. 
550. 

20. 

25. 
..": 15. 

45. 

40. 



-00 

.00 

.00 

.00 

.00 

.00 

.00 

.00 

.00 

.00 

.00* 

.00 

-00 

• CC 

■ 00 

.00 

.00 

.50* 

.00* 

.00 

.00 

.00 

.00 

00 

00 
.00 

00 

00 

00 

00 

00 

00 

00 

00 

00 



6 

5. 

8.00 



00 
00 



00 
00 
50 



00 
00 
00 



18.00 
50.00 



8.00 

6.00 

6.00 

10.00 

5.00 

20.00 

50.00 



12.00 

12.00 

5.00 

7.00 

1 . 00 

25.00 

25.00 

10.00 

35.00 

6 1 5 . 00 

345.00* 

10.00 

10.00 

135.00 

35 . 00 

175.00 

600 . 00 

33.00* 

759.00* 

350 . 00 

25.00 

285 . 00 

500 . 00 

250.00 

65.00 

23.00 

685.00 

560 . 00 

575.00 

550 . 00 

15.00 

25.00 

12.00 

45.00 

40.00 



3.00 
4.00 
8.00 
6.00 



00 
00 
50 
00 
00 



10.00 

3.00 

15.00 

50.00 



43.00 


45.00 


40.00 


40.00 


43.00 


45.00 


. 40.00 


40.00 


5 . 00 


5.00 


7.50 


1 .00 


12.00 


12.00 


12.00 


10.00 


10.00 


12.00 


20.00 


10.00 


35.00 


50.00 


40.00 


35.00 


50.00 


50.00 


50.00 


35.00 


12.00 


15.00 


15.00 


12.50 


25.00 


25.00 


25.00 


25.00 


650.00 


650.00 


650.00 


600.00 


400.00' 


625.00* 


495.00* 


400-00* 


10.00 


8-00 


16.00 


16.00 


1 5 . 00 


15-00 


15.00 


15.00 


125.00 


140.00 


14 0.00 


140.00 


50.00 


50.00 


50.00 


50.00 


175.00 


175.00 


125.00 


175.00 


600.00 


600.00 


600.00 


600.00 


39.50* 


41 .50* 


50.00* 


43.50* 


869.00» 


913.00* 


1199.00* 


957.00* 


350.00 


350.00 


400.00 


350.00 


24.00 


30.00 


35.00 


25.00 


300.00 


300.00 


300.00 


300.00 


400.00 


500.00 


600.00 


475.00 


300. OQ 


300.00 


365.00 


300.00 


35.00 








25.00 








685.00 








445.00 








575.00 


575.00 


600.00 


575.00 


500.00 








15.00 


15.00 


20.00 


15.00 


30.00 


30.00 


30.00 


30.00 


22.00 


22.00 


20.00 


22.00 


46.00 


46.00 


46.00 


46.00 


.39.75 


39.75 


38.00 


39.75 


3.00 


5.00 


4.00 


3.00 


4.00 


4.00 


4.00 


3.50 


8.00 


8.00 


8.00 


6.00 


7.00 


5.00 


6.00 


5.00 


3.00 


3.50 


3.50 


3.00 


5.50 


5.00 


6.00 


5.00 


5.00 


5.00 


5 . 00 


4.00 


7.00 


5.00 


6.00 


5.00 


5.00 


5.00 


6.00 


5.00 


8.50 


6.50 


8.00 


8.00 


5.00 


5.00 


5.00 


3.50 


16.00 


20.00 


18.00 


15.00 


50.00 


50.00 


50.00 


50.00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



8k 









MONTANA 






85 



MONTANA 




One Locality - Statewide 



86 



1977 PREVAILING CHARGE SUMMARY DATA 



MONTANA PHYSICIANS SERVICE 



MONTANA 



PROCEDURE DESCRIPTION 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 

MT 



LOCALITY DESIGNATION FOR SPECIALIST 



MT 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
1 1 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



INITIAL 
INITIAL 
MINIMAL 
ROUTINE 
ROUTINE 
INITIAL 
INITIAL 
ROUTINE 
BIOPSY 



LIMITED OFFICE 
COMP OFFICE 

OFFICE VISIT 
8RIEF OFFICE VISIT 

HOME VISIT 

HOSPITAL VISIT 

HOSPITAL 

HOSPITAL 



BRIEF 
BRIEF 
COMP 
BRIEF 
SKIN 



VISIT 
VISIT 



VISIT 
VISIT 



RADICAL MASTECTOMY 

REDUCTION OF FRACTURE 

ARTHOTMY 

NEEDLE PUNCTURE OF BURSA 

BRONCHOSCOPY 

THORACENTESIS 

CATHETERIZATION 

INSERTION OF PACEMAKER 

BLOOD TRANFUSION 

COLECTOMY 

APPENDECTOMY 

SIGMOIDOSCOPY 

HEMORRHOIDECTOMY 

CHOLECYSTECTOMY 

REPAIR HERNIA 

CYSTOSCOPY 

DILATION OF URETHRA 

PROSTATECTOMY 

ELECTROSECTION OF PROSTATE 

HYSTERECTOMY 

EXTRACTION OF LENS 

X-RAY CHEST 

X-RAY SPINE 

X-RAY HIP 

X-RAY STOMACH 

X-RAY COLON 

C03ALT 

RADIOTHERAPY 

HEMOGLOBIN 

WHITE CELL COUNT 

COMPLETE BLOOD COUNT 

CHOLESTERAL BLOOD COUNT 

HEMATOCRIT 

PROTHROMBIN 

SEDIMENTATION RATE 

BLOOD SUGAR 

BUN UREA NITRATE 

PAP TEST 

URINALYSIS 

ELECTROCARDIOGRAM 

ELECTROENCEPHALOGRAM 



12.50 

30.00 

6.00 

8.93 

14.00 

22.50 

40.00 

8.93 

18.00 

528.26 

518.65 

18.00 

18-00 

21 .60 



540.00 
255.20 
18-00 
2 1 . 00 
435.00 
267.96 



586.96 

528.26 

15.00 
26.50 
18.75 
52.50 
45.00 



3.00 
3.00 
7.50 
6.60 
3.00 
5.00 
4.20 
6.00 
6.50 

10.00 
3.60 

22.50 



iii!mii- WSS i 





15.00 


01 




44.66 


02 




6.00 


03 




9.00 


04 




15.31 


05 




24.90 


06 




52.50 


07 




9.00 


08 




18.00 


09 




535.92 


10 




645.66 


11 




18.00 


12 




18.00 


13 




114.35 


14 




24.05 


15 

15 




265.00 


17 




6.00 


18 




540.00 


19 




300.00 


20 




22.97 


21 




225.00 


22 




450.00 


23 




278.00 


24 




36.00 


25 




90.00 


26 




586.96 


27 




586.96 


28 




585.25 


29 




586.96 


30 




15.00 


31 




26.25 


32 




18.00 


33 


:>x&: : ; : v ; : 


52.50 
45.00 


35 
36 
37 




2.45 


38 




2.50 


39 




8 . 93 


40 




7.05 


41 




2.50 


42 




5.10 


43 


v :■:'. ■ -■..-;■' 


4.25 
6.00 


44 
45 




7.40 


46 




10.00 


47 




3.83 


48 




22.97 


49 
50 



87 



NEBRASKA 





1 SIOUX 


DAWES ] 






CHERRY 








KEYA F 


AHA 
ROCK 


BOYD \ 


KNOX 


CEDAR 


DIXON Jl > __ 






BOX BUTTE 
1 ) 






| BROWN 


HOLT 
















ANTELOPE 


PIERCE 










i 




WAYNE 


THURSTON >. 






SCOns BLUFF 

III 


f 

GRANT 
"ORRILL \ ' 


HOOKER 


THOMAS 


BLAINE 


LOUP 


GARFIELD 


WHEELER 




MADISON 1 STANTON 


CUMING 








BOONE 












Xl 






BANNER 




GARDEN 


ARTHUR 


MCPHERSON 


LOGAN 


CUSTER 


VALLEY 


GREELEY 


111 
PLATTE 


IcOLFAxI 


Ill | 

DODGE 1 

SAUNDERS 




KIMBALL 


CHEYENNE 




1 


SHERMAN 


HOWARD 




BUTLER 


k DOUGLAS 


r* 1 


1 I 


DEUEL 


KEITH 

LIN 


CO 

I 


LN 


MERRICK j 




V SARPY 
CASS 


Xin 






PERKINS 


I 


DAWSON mirrn n 


HALL 

[I 


■^HAMILTON 


YORK 


SEWARD 1 


I 1 

LANCASTER 






1 




i: 


OTOE 






CHASE 


HAYES 


FRONTIER 


r 


GOSPER 


PHELPS 


KEARNEY 


ADAMS 

_ ■■ 


CLAY 




FILLMORE 


SALINE 














JOHNSON 


HtMAHA / 






DUNOV 


HITCHCOCK 


REO WILLOW 


FURNAS 


HARLAN 


FRANKLIN 


WEBSTER 


NUCKOLLS THAYER 


JEFFERSON 




GAGE 

III 


PAWNEE 


richardsonX 



Three Localities : 

I - Douglas and Lancaster Counties 
HI - Counties over 2£,000 population - Adams, Buffalo, Dodge, Gage, 
Hall, Lincoln, lladison, Platte, Sarpy, Scotts Bluff 
IV - Remaining 81 counties under 25,000 population 



1977 PREVAILING CHARGE SUMMARY DATA 



MUTUAL OF OMAHA INSURANCE CO. 



NEBRASKA 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL! COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



LOCALITY DESIGNATION FOR 
REG I 



17.70 
35.00 
7.70 
7.70 
15.00 
25.50 
45.00 
8.90 
20.00 
523.30 
400.00 
15.00 
15.00 
125.00 
25.00 
225.00 
750.00 
15.00 
638.20 
240.00 
19.20 
223.40 
360.00 
216.00 
35.00 
15.00 
561 .60 
510.60 
490.00 
446.70 
18.50 
25.50 
19.20 
35.00 
38.30 
20.00 
55.00 
4.00 
4.00 
8.50 
7.00 
4.00 
B.OO 
4.00 
6.00 
7.00 
10.00 
4.00 
19.20 
50.00 



REG 


Ill 


19 


20 


35 


.00 


7 


.70 


7 


.70 


12 


• 00 


25 


.00 


40 


.00 


7 


.70 


20 


• 00 


523 


• 30 


400 


■ 00 


10 


.00 


10 


■ 00 


125 


■ 00 


25 


• 00 


225 


■ 00 


750 


.00 


15 


.00 


638 


• 20 


240 


.00 


17 


.00 


223 


40 


360 


00 


216 


00 


35 


00 


15 


00 


561 


60 


510 


60 


490 


00 


446 


70 


18 


50 


30 


00 


19 


20 


44. 


70 


38. 


30 


20. 


00 


55. 


00 


3. 


25 


3. 


00 


8. 


00 


6. 


50 


2. 


00 


6. 


00 


3. 


00 


6. 


00 


9. 


80 


7. 


50 


4. 


00 


19. 


20 


50. 


00 



GENERAL PRACTICE 
REG IV 



LOCALITY DESIGNATION FOR SPECIALIST 
REG I 



19.20 


20.00 


35.00 


51 . 10 


6.40 


10.00 


6.40 


10.00 


10.50 


15.00 


19.20 


38.30 


40.00 


50.00 


7.70 


10.00 


19.20 


20.00 


523.30 


574.4Q 


400.00 


570.00 


10.00 


15.00 


12.00 


15.00 


1 25 . 00 


125.00 


30.00 


31 .90 


225.00 


223.40 


750.00 


750.00 


15.00 


15.00 


638.20 


638.20 


240.00 


250.00 


19.20 


19.20 


234.40 


225.00 


360.00 


450.00 


2 1 6 . 00 


300.00 


35.00 


35.00 


15.00 


15.00 


561 -60 


561 .60 


5 1 . 60 


500.00 


4 90.00 


500.00 


446.70 


446.70 


16.00 


2 1 . 00 


25-00 


31.90 


19.20 


26.80 


50.00 


57.00 


38.30 


50.00 


20.00 


20.00 


55.00 


55.00 


3.00 


3.00 


3.00 


3.00 


8.40 


8.50 


7.00 


8.00 


3.00 


3.00 


6.50 


6.00 


5.00 


3.50 


6 . 00 


6.50 


8.00 


7.00 


10.00 


10.00 


3.50 


4.50 


19.20 


19.20 


50.00 


50.00 



REG 


Ill 


19 


.20 


38 


.30 


7 


.70 


7 


-70 


13 


.00 


30 


.00 


40 


.00 


8 


.00 


21 


.00 


450 


.00 


561 


.60 


15 


.00 


12 


.80 


125 


.00 


25 


.00 


223 


.40 


750 


.00 


15 


.00 


500 


.00 


250 


.00 


19 


.20 


225 


00 


382 


90 


250 


00 


35 


00 


10 


00 


561 


60 


510 


60 


446 


70 


478 


70 


21. 


00 


36. 


00 


28. 


OQ 


57. 


00 


50. 


00 


20. 


00 


55. 


00 


3. 


00 


3. 


50 


8. 


00 


6. 


50 


3. 


oo 


6. 


00 


3. 


50 


6. 


00 


7. 


00 


5. 


00 


4. 


00 


18. 


00 


50. 


00 



REG IV 




20.00 


01 


44.70 


02 


6.40 


03 


6.40 


04 


12.80 


05 


25.00 


06 


40.00 


07 


7.50 


08 


21 .00 


09 


525.00 


10 


5 1 . 60 


11 


12.00 


12 


12.80 


13 


125.00 


14 


35.00 


15 


22 3.40 


16 


750.00 


17 


15.00 


18 


638.20 


19 


250.00 


20 


19.20 


21 


225.00 


22 


375.00 


23 


255.30 


24 


35.00 


25 


15.00 


26 


561 .60 


27 


5 1 . 60 


28 


490.00 


29 


446.70 


30 


21 .00 


31 


36.00 


32 


28.00 


33 


57.00 


34 


50.00 


35 


20.00 


36 


55.00 


37 


3.00 


38 


3.00 


39 


8.50 


40 


6.00 


41 


3.00 


42 


7 . 00 


43 


3.50 : 


44 


7.00 


45 


8.00 


46 


9.00 


47 


4.00 


48 


16.50 


49 


50.00 


50 



89 



NEVADA 




Henderson 
Boulder City— -V 
Four Localities: 

01 - Las Vegas, North Las Vegas, Henderson, 

and Boulder City 

02 - Reno, Carson City, and Sparks 

03 - Elko and Ely 
99 - Rest of State 

(The city boundaries are the exact boundaries of the localities*) 



-fiiwj-oi- North 1 as Vegas 



90 



\ 



1977 PREVAILING CHARGE SUMMARY DATA AETNA LIFE AND CASUALTY 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



NEVADA 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



01 



02 



03 



99 



01 



02 



03 



99 



19.10 


35.00 


19.10 


16.00 


20.00 


25.00 


20.00 


20.00 


63.80 


53.60 


60.00 


60 . 00 


70.00 


52.50 


. 70.00 


70.00 


5.00 


6.40 


5.00 


5.00 


7.30 


7.70 


7.70 


7. 70 


12.00 


10.20 


9.60 


10.20 


12.80 


15.00 


10.90 


13.40 


20.00 


19.10 


20.00 


12.50 


25.50 


15.00 


15.00 


15.00 


31 .90 


31 .90 


31 -90 


31 .90 


31 .90 


31 .,90 


31 .90 


31 .90 


70.00 


55.00 


66.00 


66.00 


75.00 


55.50 


75.00 


75.00 


12.80 


12.00 


12.80 


10.20 


19.10 


15.00 


15.00 


15.00 


44.70 


30.00 


31 .90 


31 .90 


31 .90 


30.00 


30.00 


30.00 


825.00 


825.00 


825.00 


825.00 


750.30 


803.90 


803.90 


803.90 


918.70 


918.70 


9 1 8 . 70 


918.70 


857.50 


918.70 


918.70 


918. 70 


23.00 


19. 10 


19.10 


17.90 


19. 10 


21 .70 


19.10 


19. 10 


20-40 


20.00 


21 .60 


21 .60 


19. 10 


23.00 


23-00 


23.00 


162.10 


162. 10 


162.10 


162. 10 


160.80 


1 53 . 1 


172.00 


172.30 


38.00 


38.00 


38.00 


38.00 


35.00 


34.00 


38.30 


38. 30 


252.00 


252.00 


252.00 


252.00 


252.00 


252.00 


252.00 


252.00 


765.30 


765.60 


765.60 


765.60 


765.60 


765.60 


765.60 


765.60 


22.20* 


20.60* 


21 .20* 


18.40* 


22.40* 


22.00* 


20.00* 


22.40* 


865.00 


865.00 


865.00 


865 . 00 


900.00 


846.00 


800.00 


846. 00 


400.00 


400.00 


400.00 


400 . 00 


428.70 


440.00 


446.00 


446.00 


34.50 


30.00 


31 .90 


25.00 


38.30 


28.00 


34.50 


34.50 


329.00 


329.00 


329.00 


329 . 00 


320.00 


321 .60 


320.00 


320.00 


643. 10 


638. CO 


638.80 


638.00 


675.00 


681 .00 


681 .00 


681 .00 


382.80 


375. 10 


332.80 


382 . 80 


446.60 


408.00 


446.60 


446.00 


50.00 


50.00 


50.00 


50.00 


50.00 


50.00 


50.00 


50. 00 


19.10 


19.10 


19. 10 


19.10 


15-00 


19.10 


15.75 


15.75 


88.80* 


114.30* 


1 17.70* 


102. 10* 


1 14.30* 


123. 20* 


123. 20* 


123. 20* 


920.00 


920.00 


920.00 


920 . 00 


857.50 


920.00 


920.00 


920. 00 


815.00 


815.00 


8 1 5 . 00 


8 1 5 . 00 


750.30 


750. 30 


800.00 


800.00 


829.40 


829.40 


829.40 


82940 


800.00 


8 1 6 . 60 


829.40 


829.40 


19. 10 


19. 10 


19. 10 


15.00 


15.30 


15.30 


15.30 


15.30 


26.80 


31 .90 


30.60 


30 . 60 


23.00 


30.00 


30.00 


30.00 


26.00 


26.00 


26.00 


26.00 


28.00 


28.70 


28.00 


28.00 


55. 10 


51 .00 


57-00 


57.00 


55.00 


62.00 


59.00 


59.00 


57.00 


52.00 


57.00 


57.00 


45.90 


60.00 


60.00 


60.00 


30.00 


30.00 


30.00 


30.00 


30.00 


30.00 


30.00 


30.00 


32.00* 


38.40* 


36.80* 


29.60* 


32.00* 


39.20* 


39.20* 


39.20* 


6.00 


3.00 


5.00 


4.00 


3.50 


4.00 


4. 00 


4.00 


3.00 


3.00 


3.00 


4.00 


4.50 


4.50 


4.50 


4.50 


12.00 


,11 .00 


1 2 . 00 


12.00 


10.00 


14.00 


1 . 00 


10.00 


10.00 


7.50 


1 . 00 


10.00 


8.00 


12.50 


12.50 


12.50 


4.00 


3.00 


3.50 


3 . 50 


4.00 


4.00 


4.00 


4.00 


6.00 


5.00 


7.00 


7.00 


7.00 


■V 5.50 


7.00 


7.00 


5.50 


7.00 . 


7 . 00 


7.00 


6.00 


7.00 


7.00 


7. 00 


10.00 


9 . 00 : 


9.00 


10.00 


8.00 


8.50 


8.50 


8.50 


6.00 


8.00 


8.00 


8.00 


8.00 


8.00 


8.00 


8.00 


10.00 


10.00 


10.00 


8.00 


10.00 


8.50 


10.00 


10.00 


6.00 


4.00 


5.50 


5.00 


5.00 


4.00 


5.00 


5.00 


30.00 


30.00 


30.00 


25.50 


25.00 


28.00 


27.50 


27.50 


60.00 


60.00 


60.00 


60.00 


60.00 


60.00 


60.00 


60.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 
32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



91 



NEW HAMPSHIRE 
















One Locality - Statewide 



92 



1977 PREVAILING CHARGE SUMMARY DATA NEW HAMPSHl RE- VERMONT B/S 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DtSCRlPTION 



01 



01 


INITIAL LIMITED OFFICE VISIT 


12.00 


02 


INITIAL COMP OFFICE VISIT 


25.00 


03 


MINIMAL OFFICE VISIT 


5.00 


04 


ROUTINE BRIEF OFFICE VISIT 


9-00 


05 


ROUTINE BRIEF HOME VISIT 


1 1 .50 


06 


INITIAL BRIEF HOSPITAL VISIT 


26.00 


07 


INITIAL COMP HOSPITAL VISIT 




08 


ROUTINE 8RIEF HOSPITAL VISIT 


10.00 


09 


BIOPSY SKIN 


15.00 


10 


RADICAL MASTECTOMY 




11 


REDUCTION OF FRACTURE 




12 


ARTHOTMY 


15.00 


13 


NEEDLE PUNCTURE OF BURSA 




14 


BRONCHOSCOPY 




15 


THORACENTESIS 


25.00 


16 


CATHETERIZATION 




17 


INSERTION OF PACEMAKER 




18 


BLOOD TRANFUSION 


12.80 


19 


COLECTOMY 




20 


APPENDECTOMY 




21 


SIGMOIDOSCOPY 


20 . 00 


22 


HEMORRHOIDECTOMY 




23 


CHOLECYSTECTOMY 




24 


REPAIR HERNIA 




25 


CYSTOSCOPY 




26 


DILATION OF URETHRA 




27 


PROSTATECTOMY 




28 


ELECTROSECTION OF PROSTATE 


200.00 


29 


HYSTERECTOMY 




30 


EXTRACTION OF LENS 




31 


X-RAY CHEST 




32 


X-RAY SPINE 




. 33 


X-RAY HIP 




34 


X-RAY STOMACH 




35 


X-RAY COLON 




36 


COSALT 




37 


RADIOTHERAPY 




38 


HEMOGLOBIN 


3.00 


39 


WHITE CELL COUNT 


3.50 


40 


COMPLETE BLOOD COUNT 


7.00 


41 


CHOLESTERAL BLOOD COUNT 


6.00 


42 


HEMATOCRIT 


3.00 


43 


PROTHROMBIN 


6.00 


44 


SEDIMENTATION RATE 


5.00 


45 


BLOOD SUGAR 


5.00 


46 


BUN UREA NITRATE 


5.00 


47 


PAP TEST 


11 .00 


48 


URINALYSIS 


3.50 


49 


ELECTROCARDIOGRAM 


16.00 


50 


ELECTROENCEPHALOGRAM 





NEW HAMPSHIRE 
LOCALITY DESIGNATION FOR SPECIALIST 

01 



15.00 
31 .90 
5.00 
10.00 
12.80 



30.00 
35.00 
1 1 .00 
15.00 
535.90 
630.00 
15.00 

125.00 

31 .90 



12.80 
550.00 
285.00 

30.00 

446.60 

275.00 

65.00 

612.50 

560.00 

400.00 

500.00 

6.50 

26.00 

7.00 

20.00 

20.00 

10.00 

12.00 

3. 

2. 

6. 

7. 

2. 

5. 



AfMZM:Mixmiii : ">& 



.00 
50 
.00 
.00 
.50 
.00 
5.00 
6.00 
6.00 
8.00 
4.00 
19. 10 
50.00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 

11 

12 

13 
14 
15 

16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



93 



NEW JERSEY 




Three Localities: 

01 Bergen, Essex, Hudson, Hunterdon, Middlesex, Morris, 
Passaic, Somerset, Sussex, Union, Warren Counties 

02 Burlington, Mercer, Monmouth, and Ocean Counties 

03 Atlantic, Camden, Cape May, Cumberland, Gloucester, 
Salem Counties 



914 



1977 PREVAILING CHARGE SUMMARY 


DATA 


PRUDENTIAL INSURANCE«COMPANY 


NEW JERSEY 










LOCALITY 


DESIGNATION FOR GENERAL PRACTICE 


LOCALITY 


DESIGNATION FOR 


SPECIALIST 




PROCEDURE DESCRIPTION 




I 


II 


III 


I 


II 


III 




01 INITIAL LIMITED OFFICE 


VISIT 


19.10 


20.00 


16.00 


30.00 


25.50 


25.50 


01 


02 INITIAL COMP OFFICE 


VISIT 


30.00 


26.00 


25.00 


38 . 30 


38.30 


31.90 


02 


03 MINIMAL OFFICE VISIT 




10.00 


10.00 


8.90 


12.80 


. 12.80 


12.80 


03 


04 ROUTINE BRIEF OFFICE VISIT 


10.00 


10-00 


8.90 


12.80 


12.80 


12.80 


04 


05 ROUTINE BRIEF HOME VISIT 


15.00 


12.80 


1 2 . 00 


19.10 


19. 10 


15.30 


05 


06 INITIAL BRIEF HOSPITAL 


VISIT 


30.00 


30.00 


31 .90 


44.70 


44.70 


38.30 


06 


07 INITIAL COMP HOSPITAL 


VISIT 


30.00 


30.00 


31 .90 


31 .90 


31 .90 


31 .90 


07 


08 ROUTINE BRIEF HOSPITAL 


VISIT 


12.80 


11 .00 


10.00 


15.00 


15.00 


12.80 


08 


09 BIOPSY SKIN 




35.00 


40.00 


18.00 


63.80 


50.00 


50.00 


09 


10 RADICAL MASTECTOMY 




500.00 


500.00 




765. 60 


765.60 


650.80 


10 


11 REDUCTION OF FRACTURE 




765.60 




765.60 


950.00 


765.60 


765.60 


11 


12 ARTHOTMY 




18.00 


1 5 . 00 


15.00 


20.00 


20.00 


22.00 


12 


13 NEEDLE PUNCTURE OF BURSA 


18.00 


19. 10 


1 5 . 00 


20.00 


20.00 


25.00 


13 


14 BRONCHOSCOPY 






133.00* 


124.50* 


191.40 


; 200.00 


157.50 


14 


15 THORACENTESIS 




50.00 


40.00 


50.00 


75.00 


63.80 


50.00 


15 


16 CATHETERIZATION 




250.00 


322.00* 




3 1 9 . 00 


250.00 


3 1 9 . 00 


16 


17 INSERTION OF PACEMAKER 






920.00* 




900.00 


800.00 


800.00 


17 


18 BLOOD TRANFUSION 




25.00 




25.00 


25.00 






18 


19 COLECTOMY 




700.00 


400.00 




930.00 


893.00 


765.60 


19 


20 APPENDECTOMY 




260.00 


260.00 




401 .90 


408.30 


350.90 


20 


21 SIGMOIDOSCOPY 




30.00 


25.00 


25.00 


40 . Oo 


35.00 


40.00 


21 


22 HEMORRHOIDECTOMY 




319.00 


3 1 9 . 00 




350.0Q 


300.00 


274.30 


22 


23 CHOLECYSTECTOMY 




500.00 


548-70 




638.00 


599.70 


510.40 


23 


24 REPAIR HERNIA 




320.00 


250.00 


.'■■. 350.90 : 


395.00 ■:'■ 


' : - 382.80 


319.00 


24 


25 CYSTOSCOPY 




25.00 




41-50* 


50.00 


62.50 


50.00 


25 


26 DILATION OF URETHRA 




14.00 


20.00 


19.10 


19. 10 


23.00 


15.00 


26 


27 PROSTATECTOMY 




341 .00 






850.00 


765.60 


650.00 


27 


28 ELECTROSECTION OF PROSTATE 


800.00* 






765.60 


795.00 


638.00 


28 


29 HYSTERECTOMY 




590.00 


600.00 




750.00 


638.00 


606. 10 


29 


30 EXTRACTION OF LENS 




800.00* 






750.00 


638.00 


638:00 


30 


31 X-RAY CHEST 




19. 10 


: 20.00 


20 . 00 


24.00 


20.00 


20.00 


31 


32 X-RAY SPINE 




31-90 


35-00 


25.50 


38.30 


38 . 00 


40.00 


32 


33 X-RAY HIP 




27-50 


25.00 


26.00 


30.00 


27.00 


25.00 


33 


34 X-RAY STOMACH 




63.60 


55.00 


51 .00 


63.80 


55.00 


50.00 


34 


35 X-RAY COLON 




60 . 00 


' 60.00 


50.00 


55.00 


50.00 


50.00 


35 


36 COBALT 










30.00 


31 .90 


27.00 


36 


37 RADIOTHERAPY 










30.00 


30.00 


27.00 


37 


38 HEMOGLOBIN 




5.00 


4.00 


3.00 


3.00 


3.00 


5.00 


38 


39 WHITE CELL COUNT 




5.00 


5.00 


5.00 


3.00 


4.00 


1 .00 


39 


40 COMPLETE BLOOD COUNT 




7.00 


10.00 


7 . 00 


7.00 


7 .00 


8. 00 


40 


41 CHOLESTERAL BLOOD COUNT 




6.00 


7.00 


6.00 


6.00 


5.00 


5.00 


41 


42 HEMATOCRIT 




5.00 


4.00 


3.00 


4.00 


3.00 


5.00 


42 


43 PROTHROMBIN 




6.00 


7.00 


5.00 


6.00 


6.00 


5.00 


43 


44 SEDIMENTATION RATE 




5.00 


5.00 


5.00 


5.00 


5.00 


5.00 


44 


45 BLOOD SUGAR 




6.00 


' 6.00 


5.00 


5.30 


:v:v:-:v:v»:-;v:-.-:'»v: - ■ ■ 

5.00 


5.00 


45 


46 BUN UREA NITRATE 




6.00 


6.00 


5.00 


6.00 


5.50 


6.00 


46 


47 PAP TEST 




10.00 


10.00 


9.00 


10.00 


10.00 


10.00 


47 


48 URINALYSIS 




4.00 


4.00 


3.00 


5.00 


5.00 


3.00 


48 


49 ELECTROCARDIOGRAM 




25.00 


25.00 


25.00 


25.00 


20.00 


25.00 


49 


50 ELECTROENCEPHALOGRAM 




35.00 






45.00 


50.00 


60.00 


50 



95 



■ . 




' 






V— 



'., 01 - Los Alamos, Santa Fe and Albuquerque (cities) 
02 - Rest of State 

(Locality* is determined by the city in the 
return address) 



- 



96 



1977 PREVAILING CHARGE SUMMARY DATA EQUITABLE LIFE ASSURANCE SOCIETY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



NEW MEXICO 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



;.;.....;,,.-.:.;.:.„;,,.:., 



01 

13.30 

36.50 

6.00 

9.30 

20.90 

20.80 

46.80 

9.30 

20.80 

648 . 00 

665.30 

18.00 

12.50 

165.90 

26.00 

287.00* 

820. CO- 

16.40* 

629.00 

358.50 

30.50 

260.00 

442. 70 

260.60 

43.20 

10.90 

680.00 

582.40 

625.00 

531 .00 

13.50 

26.00 

27.00 

58.25 

58.25 

15.60 



31 
3 
3 



60* 

10 

10 



8.30 
B.00 



.60 
.70 
.20 
.25 

.40 



02 

15.60 

45.75 

4.70 

10.00 

15.00 

20.80 

46.50 

8.80 

20.80 

647.80 

572.00 

16.00 

20.80 

162.00 

26.00 

273.00* 

780.00* 

15.60" 

567.00 

358.40 

26.00 

260.00 

468 . 00 

283. 10 

36.40 

11 .50 

780 . 00 

675.50 

625.00 

621 .40 

14.60 

22.80 

22.90 

46.80 

47.80 

15.60 

32.00* 



10 
10 



10.60 

4.20 

22.90 

45.50 



e.eo 

8.30 

3.00 

6. 10 

4.80 

6.50 

9.40 

10.40 

4.20 

17.20 

45.50 



■. 



01 

15.60 

48.50 

8.00 

10.60 

19.90 

20.80 

49.80 

10.40 

20.80 

642.70 

665.30 

19.90 

15.60 

165. 90 

33.20 

269. 50* 

770.00* 

15.40* 

796.50 

358.40 

26.00 

260.00 

527.80 

329.90 

43.20 

11 .50 

680.00 

680.00 

625.00 

630.50 

15.60 

21 .80 

19.90 

48.00 

46.50 

. 15.60 



31 
3 
4 
9 



20* 
10 
20 
00 



10.00 
3. 10 
6.75 
5.40 



.25 
,80 



8.50 

4.60 

20.00 

45.50 



02 

13.30 

46.80 

5.20 

8.50 

13.30 

16.60 

41 .60 

6.60 

20.80 

648.00 

665.30 

18.60 

15.60 

165.90* 

26.00 

332.50* 

950.00* 

19.00* 

629.00 

358.50 

26.00 

260.00 

442.70 

260.60 

43.20 

11 .50 

680.00 

675. 70 

625.00 

621 .40 

13.50 

24.30 

22.90 

48.00 

47.80 

15.60 

28.00* 

4.20 

3. 10 

8.30 

9.40 

3.00 

5-20 

4.20 

6.25 

7.80 

8.30 

4.20 

18.75 

45.00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



97 



NEW YORK 



I - Syracuse 



B/S of Western New York 



I - Ogdensburg. 
I - Fayetteville 



tica - I 
ew Hartford - I 
ooperstown - I 



Glens Falls - I 




Al bany, schenectady-trqy Saratoga 

Springs - I 
Schenectady, Troy - I. 
.bany - I • 



Ten Localities: 

B/S of Greater New York - A, B, E, H,& N 

Metropolitan Life Insurance Co. - I & II 

Group Health Insurance - Queens County 

B/S of Western New York - Alleghany, Cattaraugus, Erie, 

Genesee, Niagara, Orleans & Wyoming Counties 
Genessee Valley Medical Care Inc. - Livingston, Monroe, 
Seneca, Wayne & Yates Counties 

(For more locality information 
see Appendix A) 



Group Health Insurance 



98 



* 



1977 PREVAILING CHARGE SUMMARY DATA 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE 8RIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



DATA B/C-B/S OF 


GREATER 


NEW YORK 






MEW YORK 










LOCALITY 


DESIGNATION FOR 


GENERAL PRACTICE 


LOCALITY DESIGNATION FOR 


SPECIALIST 




A 


B 


E 


H 


N 


A 


B 


E 


H 


N 




25.00 


20.00 


19.10 


17.00 


10. 00 


44.70 


31.90 


31.90 


25.00 


19.10 


f 01 


25.50 


20 .00 


25-00 


19. 10 


19.00 


44.70 


35 . 00 


35.00 


35.00 


15.00 


02 
03 


15.00 


12.80 


12.80 


11 .50 \ 


8. 00 


25.00 


■ 19.10 


19-10 


15.00 


10. 00 


04 


20.00 


19.10 


19.10 


15.30 


12.00 


31 .90 


20.00 


25.00 


19. 10 


15.00 


05 

06 


25.50 


25.50 


31 .90 


25.00 


20.00 


50.00 


38.30 


38.30 


38.30 


30.00 


07 


20.00 


19.10 


19. 10 


15.00 


10.00 


29.20 


20.00 


21 .90 


19.10 


10.00 


08 


40.00 


31 .90 


33.80* 


44.70 


44.70 


50.00 


38.30 


44.70 


45.00 


45.00 


09 


797.50* 


765.60* 


638.00* 


638.00* 


638.00* 


1276.00 


1025.00 


957.00 


765.60 


765.60 


10 


925.10* 


836.00* 


901 .60* 


726.00* 


726.00* 


1220.00* 


1020. 80* 


1128.00* 


829.40* 


829.40* 


11 


31 .90 


31 .90 


31 .90 


25.00 


25.00 


44.70 


31 .90 


31 .90 


35.00 


35.00 


12 


25.00 


31 -90 


25.50 


25.00 


25.00 


44.70 


31 .90 


35.00 


30.00 


30.00 


13 


184.40* 


187. 10* 


169. 10* 


140.00* 


140.00* 


255.20 


216.90 


255.20 


191 .40 


191 .40 


14 


36.90* 


63.80 


33.80* 


42.00 


42-00 


82.90 


69.00 


76.60 


63.80 


63.80 


15 


300.00* 


319.00* 


250.00* 


255.20* 


255.20* 


300.00 


319.00 


250.00 


319.00* 


319.00* 


1 5 


335.00* 


300.00* 


382.80* 


335.90* 


335.90* 


500.00 


350.00 


400.00 


382. 80 


382.80 


17 


24.60* 


45.00 


44. 70* 


16.40 


16.40 


63.80 


47.50 


20.00 


38.00 


38.00 


18 


1 148.40* 


1020.80* 


893.20* 


765. 10* 


765. 10* 


1595.00 


1276.00 


1212.20 


988.90 


988.90 


19 


446.60* 


478.50* 


414.70* 


373.20* 


373.20* 


500.00 


574.20 


561 .40 


500.00 


500.00 


20 


30.00 


31 -90 


25.00 


30.00 


30.00 


40.00 


31 .90 


31 .90 


38.00 


38.00 


21 


368.70* 


374. 10* 


338. 10* 


273.90* 


279.90* 


550.00 


478.50 


414.70 


446.60 


446.60 


22 


701 -80* 


700.00 


701 .80* 


559.80* 


559.80* 


1084.60 


893.20 


765.60 


701 .80 


701 .80 


23 


612.50* 


450.00 


394.50* 


326.60* 


326.60* 


701.80 


510-40 


478.50 


446.60 


446.60 


24 


102. 10 


40.00 


60.00* 


64.00 


64.00 


102.10 


95. 70 


60.00 


76.60 


76.60 


25 


28.00* 


31 .00* 


25.00* 


19.10* 


19.10* 


35.00 


40.00 


25.00 


19. 10 


19. 10 


26 


957.00* 


836.00* 


733.70* 


701 -80* 


701 .80* 


1276.00 


1039. 90 


925. 10 


829.40 


829.40 


27 


983.20* 


829.40* 


733.70* 


746.40* 


746.40* 


1052.70 


957.00 


829.40 


765.60 


765.60 


28 


910.00* 


748.20* 


676.20* 


559.80- 


559.80* 


1000.00 


957.00 


765.60 


701 .80 


701 .80 


29 


925. 10* 


733.70* 


829.40* 


733.70* 


733.70* 


1084.60 


957.00 


850.00 


765.60 


765.60 


30 


25.00 


20 . 00 


25.00 


20.00 


20.00 


25.00 


25.00 


25.00 


21 .70 


21.70 


31 


31 .90 


35 . 00 


35.00 


25.50 


25.50 


38.30 


35.00 


38.30 


30.00 


30.00 


32 


33.60* 


20.00 


33.00 


28.00 


28.00 


35.00 


31 .90 


35.00 


33.00 


33.00 


33 


80.00 


85.00 


75.00 


65.00 


65.00 


95.70 


85.00 


80.00 


75-00 


75.00 


34 


75.00 


75.00 


57.40 


60 . 00 


60.00 


95.00 


82.90 


75.00 


70.00 


70.00 


35 


19.10* 


20.50 


20.50* 


25.50* 


25.50* 


44.70 


25.00 


25.00 


25.00 


25.00 


3G 


13.60 


20.00 


25.00* 


25.50* 


25.50* 


35.00 


31 .90 


30.00 


25.00 


25.00 


37 


5.00 


5.00 


5.00 


3.00 


3.00 


5.00 


5.00 


4.00 


4.00 


4.00 


38 


5.00 


5.00 


3.00 


3.00 


3.00 


5.00 


5.00 


3.00 


3.50 


3.50 


39 


8.00 


8 . 00 


1 . 00 


7.00 


7.00 


10.00 


8.00 


8.00 


8.00 


8.00 


40 


7.00 


6.00 


7.00 


7.00 


7.00 


7.00 


6.00 


8.00 


7.00 


7.00 


41 


5.00 


5.00 


5.00 


5.00 


5.00 


5.00 


4.00 


5.00 


3.50 


3.50 


42 


10.00 


5.00 


8.00 


5.00 


5.00 


10.00 


6.00 


6.00 


7.00 


7.00 


43 


5.00 


5.00 


5-00 


5.00 


5.00 


5.00 


5-00 


» 5.00 


5.00 


5.00 


44 


6.00 


6.00 


7.00 


6.00 


6.00 


7.00 


6.00 


6.00 


6.00 


6.00 


45 


6.00 


6.00 


7.00 


5.00 


5.00 


7.00 


6.00 


7.00 


6.00 


6.00 


46 


10.00 


10.00 


8.00 


10.00 


10.00 


10.00 


10.00 


8.00 


8.00 


8.00 


47 


5.00 


7.00 


5.00 


4.00 


4.00 


5.00 


5.00 


15.00 


5.00 


5.00 


48 


20. 10 


25.00 


25.00 


25.00 


25.00 


27.60 


25.00 


25.00 


25.00 


25.00 


49 


60.40* 


53.10* 


60.00* 


60.00* 


60-00* 


80.00 


53.10 


60.00 


60.00 


60.00 


50 



99 



1977 PREVAILING CHARGE SUMMARY DATA METROPOLITAN LIFE INSURANCE CO. 



NEW YORK 



PROCEDURE DESCRIPTION 



01 INITIAL LIMITED OFFICE VISIT 


15.00 


02 INITIAL COMP OFFICE VISIT 


44.70 


03 MINIMAL OFFICE VISIT 


6.40 


04 ROUTINE BRIEF OFFICE VISIT 


8.90 


05 ROUTINE BRIEF HOME VISIT 


12.80 


06 INITIAL BRIEF HOSPITAL VISIT 


19.10 


07 INITIAL CCMP HOSPITAL VISIT 


50.00 


08 ROUTINE BRIEF HOSPITAL VISIT 


10.00 


09 BIOPSY SKIN 


25 . 00" 


10 RADICAL MASTECTOMY 


602. 90" 


11 REDUCTION OF FRACTURE 


612.50' 


12 ARTHOTMY 


1 6 . 60 


13 NEEDLE PUNCTURE OF BURSA 


15.00 


14 BRONCHOSCOPY 


129.30* 


15 THORACENTESIS 


25.90' 


16 CATHETERIZATION 


200.00* 


17 INSERTION OF PACEMAKER 


750.00* 


18 BLOOD TRAIMFUSION 


16. 00* 


19 COLECTOMY 


689.00* 


20 APPENDECTOMY 


340. 00* 


21 SIGMOIDOSCOPY 


25.50 


22 HEMORRHOIDECTOMY 


258.40* 


23 CHOLECYSTECTOMY 


500.00* 


24 REPAIR HERNIA 


301 .50* 


25 CYSTOSCOPY 


38 . 30* 


26 DILATION OF URETHRA 


15.30* 


27 PROSTATECTOMY 


638 . 00* 


28 ELECTROSECTION OF PROSTATE 


612 . 50* 


29 HYSTERECTOMY 


602 . 90* 


30 EXTRACTION OF LENS 


600.00* 


31 X-RAY CHEST 


20.00 


32 X-RAY SPINE 


26.30* 


33 X-RAY HIP 


31 .90* 


34 X-RAY STOMACH 


52 . 50* 


35 X-RAY COLON 


43.80* 


36 COBALT 


18.00* 


37 RADIOTHERAPY 


22.00* 


38 HEMOGLOBIN 


2.00 


39 WHITE CELL COUNT 


3 . 00* 


40 COMPLETE BLOOD COUNT 


9. 00 


41 CHOLESTERAL BLOOD COUNT 


7.00 


42 HEMATOCRIT 


4.00 


43 PROTHROMBIN 


7.00 


44 SEDIMENTATION RATE 


3.00 


45 BLOOD SUGAR 


7.00 


46 BUN UREA NITRATE 


5. 00 


47 PAP TEST 


7.00 


48 URINALYSIS 


3.00 


49 ELECTROCARDIOGRAM 


25.00 


50 ELECTROENCEPHALOGRAM 


45.90* 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 
AREA I 



LOCALITY 



AREA 


II 


12 


.80 


30 


.00 


5 


. 10 


8 


.90 


12 


.00 


23 


.00 


40 


.00 


8 


.90 


24 


.00 


558 


.30* 


612 


.50* 


15 


.00 


19 


. 10 


119 


.70 


25 


.00 


230 


.00* 


600 


.00 


20 


.00 


638 


.00 


319 


.00* 


25 


00 


239 


30* 


459 


40 


279 


20 


39 


90* 


19 


10 


600 


00* 


612 


50* 


558 


30* 


560 


00* 


19. 


10 


30. 


00 


30. 


60 


40. 


00* 


35. 


00* 


15. 


00* 


24. 


00* 


2. 


50 


3. 


00 


6. 


00 


5. 


00 


3. 


00 


4. 


00 


3. 


60 


5. 


00 


5 . 


00 


6. 


00 


3. 


00 


20. 


00 


45. 


50* 



. 



DESIGNAT 


ION FOR SPECIALIST 


AREA I 


AREA II 






20.00 


19.10 


44.70 


40.00 


8.00 


3.80 


12.00 


10.00 


15.00 


12.80 


25.50 


25.50 


44. 70 


46.40 


12.00 


10.00 


25.00 


26.80 


625.20 


574.20 


612.50 


612.50 


19. 10 


19. 10 


19. 10 


19.10 


134.00 


127.60 


40.00 


31 .90 


200.00 


230.00 


750.00 


595.00 


16.00 


20.00 


714.60 


638.00 


340.00 


319.00 


31 .90 


25.50 


268.00 


255-20 


500.00 


459.40 


319.00 


280.00 


38.30 


40.00 


15.30 


15.00 


638.00 


600.00 


612.50 


612. 50 


625.20 


561 .40 


600.00 


560.00 


19.10 


16.60 


38.30 


42.00 


31.90 


31.00 


59.00 


58.70 


49.80 


50.50 


26.00 


15.00 


30.00 


30.00 


4.00 


2.50 


3.00 


3.00 


8.60 


8.00 


5.00 


6.00 


3.00 


3.00 


4.20 


5.00 


5-00 


4.00 : 


5.00 


5.00 


5.20 


6.00 


5.00 


10.00 


4.00 


4.00 


22.00 


20.00 


45.90 


50.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

1 1 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



100 



< 



1977 PREVAILING CHARGE SUMMARY DATA GROUP HEALTH INCORPORATED 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL. COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



SINGLE 

12.80 
25.00 

10.20 
15.30 

30.00 
15.30 
35.00 



20.00 
19.10 

75.00 



30.00 

600.00 
382.80 

15.00 



20.00 
76.60 
25.50 
70.20 
76.60 



3.00 
10.00 



NEW YORK 
LOCALITY DESIGNATION FOR SPECIALIST 

SINGLE 



CO 
00 
00 

00 



5-00 



00 
00 



::*:■::: v:v: : : : : : :v:": : : : - : ' ; :% ; - : :-:':* ; v' 



15.00 



3 
21 
51 



00 
20 
00 



25. 


00 


. 35. 


00 


15. 


00 


20. 


00 


44. 


70 


19. 


10 


50. 


00 


950. 


00 


1140. 


00 


25. 


00 


31 . 


00 


250. 


00 


127 


60 


300 


00 


50 


00 


1000 


00 


469 


60 


44 


70 


446 


60 


755 


40 


500 


00 


60 


00 


19 


10 


850 


00 


900 


00 


701 


80 


893 


20 


30 


00 


102 


.10 


31 


.90 


85 


00 


75 


.00 


38 


.30 


3 


.00 


8 


.00 


10 


.00 


5 


.00 


5 


.00 


5 


.00 


5 


.00 


5 


.00 


5 


.00 


10 


.00 


5 


.00 


25 


.00 


50 


.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 



40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



101 



1977 PREVAILING CHARGE SUMMARY DATA B/S OF GREATER WESTERN NEW YORK 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 
35 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



NEW YORK 
COMBINEO LOCALITY DESIGNATION 

SINGLE 






■ 



IS 


.70 


63 


.90 


14 


.75 


S 


.80 


19 


.70 


29 


.50 


63 


.90 


9 


.80 


28 


.00 


595 


.90 


701 


.00 


21 


.00 


21 


.00 


140 


.20 


35 


• 10 


245 


.35 


560 


.80 


17 


.50 


630 


.90 


280 


-40 


35 


.10 


280 


.40 


420 


60 


245 


40 


56 


10 


21 


00 


560 


80 


560 


80 


560 


80 


560 


80 


16 


80 


28. 


60 


28. 


60 


84. 


20 


50. 


50 


14. 


10 


21 . 


10 


4. 


20 


4. 


20 


11. 


00 


7. 


00 


4. 


20 


6. 


00 


A. 


00 


7. 


00 


8. 


40 


7. 


00 


5. 


00 


29. 


50 


70. 


00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
lis 14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



102 



1977 PREVAILING CHARGE SUMMARY DATA GENESSEE VALLEY MEDICAL CARE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL CCMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD T RAN FUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



NEW YORK 
COMBINED LOCALITY DESIGNATION 
SINGLE 



:■" 



19. 

45. 

10. 

12. 

15. 

25. 
102. 

17. 

23. 
562. 
508. 

1 1 . 

10. 
115. 

35. 
192. 
770. 

12 
616 
269 

23 
231 
423 
254 

12 

577 

577 

500 

577 

18 

45 

35 

62 

62 



10 
00 
20 
00 

00 

50* 

00* 
. 85* 

• 10 * 

■ iof 

.20 
.00 

• 00 . 
.50* 

°0 
■ 5 °t 

. oo; 

■ OOx 

.ool 

.50* 

. 70* 1 ' 



.oo 1 

.50 
. 10 



ft 



oo 

50. 

50^ 

soi 

70? 

on* 

90 



3.00 
3.00 
7.40 
7.70 
2.80 
7.00 
3.90 
5.00 
5.60 
8.90 
6.30 
26.70 
69.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 






103 



NORTH CAROLINA 



GREENSBORO <?V 



WINSTON-SALEM ?V 



"y 



CHAPEL HILL ?V 



STORCS «C 



}&STQN SMC, 



gR|§n55or6-«twst6n-salem 

/ paoisom s "Jt I 

"ASHEVILLrV/ \-fa,>-y-V«»u/ x, 

xr~^ -iic«.i r Mc w«i.ti y w I 




HI_Gh|_PO!N1 

'S3OS0 • 




4 . PS r*S 'Juwwc: 3n \ 



durhamTral 

Chatham SAlf/Gwl 




?y 



RALEIGH ty 



H*VA_/y "««-"« l "\ / jy T,< "» ->TJ %\^*s~>\ 



^ 



:;«^ 




POL'S 



O'OCKr MOUNT ~l 





ASHEVILLE r-/ 








CHARLOTTE ?y. 






CAM? If Jfl/Nf 



WILMINGTON 




tf 



Two Localities: 

Area 94 - Charlotte, Durham, Greensboro, Winston-Salem, Raleigh, 

Asheville, Chapel Hill. ( Locality determined by the 

city cited in the return address.) 
Area 95. - All other cities not listed above and all rural areas. 

: The carrier's Area 93 is a Statewide specialists' screen. However, 
internists and general surgeons are included in Areas 94 &95.) 



10U 



< 



1977 PREVAILING CHARGE SUMMARY DATA PRUDENTIAL INSURANCE COMPANY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 






procedure description 

01 initial limited office visit 

02 initial comp office visit 

03 minimal office visit 

04 routine brief office visit 

05 routine brief home visit 

06 initial brief hospital visit 

07 initial comp hospital visit 

08 routine brief hospital visit 

09 biopsy skin 

10 radical mastectomy 

11 reduction of fracture 

12 arthotmy 

13 needle puncture of bursa 

14 bronchoscopy 

15 thoracentesis 

16 catheterization 

17 insertion; of pacemaker 

18 blood tranfusion 

19 colectomy 

20 appendectomy 

21 sigmoidoscopy 

22 hemorrhoidectomy 

23 cholecystectomy 

24 repair hernia 

25 cystoscopy 

26 dilation of urethra 

27 prostatectomy 

28 electrosection of prostate 

29 hysterectomy 

30 extraction of lens 

31 x-ray chest 

32 x-ray spine 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



94 



95 










15.00 


15. 10 




44.70 


44.70 




3.80 


4 . 00 




10.00 


8.00 




18.00 






20.00 


20.00 




50.00 


45.00 




10.00 


10.00 




25.00 


25.00 




560.00 


560.00 


■■■■■ 


680.00 


680.00 




14.00 


11 .00 




12.00 


12.00 




150.00 


1 50 . 00 




21 .00 


21 .00 




250.00 


250.00 




800.00 


800 . 00 




20.00 


20.00 




640.00 


640 . 00 




320.00 


320.00 


■ 


20.00 


20.00 




250.00 


250 . 00 




450. CO 


450.00 




280.00 


280 . 00 




40.00 


40.00 




15. 10 


15. 10 




640.00 


612.50 




640.00 


585.00 




520.00 


500.00 




560.00 


520 . 00 




6.00 


6.00 




11 .00 


10.00 




1 1 .50 


10.60 




21 .00 


19.50 




20.00 


17.70 




18.00 


16.75 




15.00 


14.70 




3.00 


3.00 




4.00 


3.00 




6.00 


7-20 




6.00 


6.00 




3.00 


2.80 




5.00 


5.00 




6.00 


5.00 




5.00 


5.00 




6.00 


6.00 




6.00 


8.00 




3.00 


3.00 




15.00 


15.00 




45.00 


40.00 





NORTH CAROLINA 
LOCALITY DESIGNATION 



94 

15.00 

75.00 

8.00 

1 1 .00 

15.00 

22.50 

75.00 

12.00 

25.00 

586.00 

720.00 

14.00 

12.00 

150.00 

30.00 

250.00 

875.00 

20.00 

720.00 

320.00 

25.00 

300.00 

480.00 

300.00 

40.00 

15.00 

640.00 

640.00 

500.00 

560.00 

6.00 

11 .00 

11.50 

21.00 

19.00 

18.00 

15.00 

2.50 

3.00 

8.00 

5.50 

2.50 

6-00 

4.00 

6.00 

6.00 

6.00 

3.50 

17.00 

45.00 



FOR SPECIALIST 
95 

15.00 

53 . 00 
5.00 

10.00 

15.00 

21 .00 

50.00 

11 .20 

25.00 
520.00 
664 . 00 

15.00 

10. 50 
125.00 

31 .90 
250.00 
770.00 

20.00 
600.00 
325.00 

25.00 
240.00 
445.00 
280.00 

40.00 

15.00 
640.00 
640.00 
520.00 
560.00 
6.00 



11 

t1 
21 



.00 
.50 
.00 



19.00 
18.00 
15.00 
3.00 
3.00 
8.00 
6.00 
3.00 
5.00 



4.75 
6.00 



00 
00 
00 



17.00 
45.00 



01 
02 
03 
04 
05 
06 
07 

oe 

09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
IS 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 






105 



NORTH DAKOTA 




One Locality - Statewide 



106 



< 






1977 PREVAILING CHARGE SUMMARY DATA B/S OF NORTH DAKOTA 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 C03ALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



:S: :: :;: : :i : W:"K* : S< : " : : :: v: : S:' :; S : : ; " : : : 



■ 



■:'->:<:-y-:-:-yy. 



IBSSBs'SK 



NORTH DAKOTA 
COMBINED LOCALITY DESIGNATION 

SINGLE 



12.80 

40.00 

6.40 

7.70 

13.50 

30.00 

61 .30 

7.70 

23.00 

535.90 

560.00 

15.00 

15.30 

1 1 2 . 50 

23.00 

268.00 

700.00 

10.00 

612.50 

300.00 

23-00 

229.70 

459.40 

280.00 

35.00 

21 .00 

594.80 

600.00 

535.90 

560.00 

14.00 

21.10 

25.50 

49.00 

40.80 

21 .00 

22.00 

3.00 

3.00 

10.00 

7.00 

3.00 



::":-;*:-x** : : : :-:- ,: : : : : : ; - : : : :*: ; : ; ' : . : : : :v- : : ; " : ' : :v :: - 



00 
.50 
.00 

00 



7.50 

3.75 

22.50 

50.00 



.■ 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

IS 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



107 



OHIO 



Toiroo 




Fifteen Localities! 

01 - Akron 

02 - Cincinnati 

03 - Cleveland 
Olt - Columbus 
0£ - Dayton 

06 - Lima 

07 - Mansfield 

08 - Springfield 



# 



09 - Steubenville 

10 - Toledo 

11 - Youngstown 

12 - Lake Plains 

13 - Sandusky Valley 
lh - Scioto Valley 
1$ - Ohio Valley 



108 



< 



1977 PREVAILING CHARGE SUMMARY DATA NATIONWIDE MUTUAL INSURANCE CO. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



OHIO 



LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 
1B BLOOD TRANFUS10N 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



01 



02 



03 



04 



05 



Ot 



02 



03 



04 



05 



15.00 


15.00 


15.00 


15.00 


15.00 


18.00 


19. 10 


15.00 


19. 10 


15.00 


01 


40.00 


35.00 


40.00 


35 . 00 


44 . 00 


44.70 


40.00 


44.70 


40.00 


50.00 


02 


3.00 


4 . 00 


4.20 


4.00 


3.00 


3.00 


500 


5.30 


5.00 


2.00 


03 


10.00 


8.90 


8.90 


8.90 


8.90 


12.00 


1 1 .00 


12.00 


12.00 


12.00 


04 


15.30 


12.00 


15.00 


15.00 


12.80 


19.10 


15.00 


20.00 


19. 10 


15.00 


05 


20.00 


20.00 


25.00 


25.00 


25.50 


30.00 


31 .90 


31 .90 


32.00 


35.00 


06 


35.00 


35.00 


35.00 


50.00 


44. 70 


45.00 


51 .00 


40.00 


50.00 


60.00 


07 


1 1 .00 


10.00 


10.00 


10.00 


10.00 


12.80 


12.80 


12.80 


12.00 


15.00 


08 


15.00 


25.60 


25.00 


15.00 


20.00 


25.00 


27.50 


35.00 


19. 10 


27.50 


09 


75.00 


575.00 


575.00 


575.00 


575.00 : 


558.00 


600.00 


600.00 


701 .80 


5 1 . 00 


10 


510.40 


510.40 


510.40 


510.40 


510.40 


612.50 


638.00 


638.00 


574.20 


638.00 


11 


15.30 


15.00 


19.10 


12.80 


15.00 


19.10 


18.00 


19.10 


15.00 


15.30 


12 


15.00 


15.00 


18.00 


18.00 


18.00 


20.40 


12.80 


15.00 


12.80 


12.80 


13 


127.00 


127.60 


127.60 


127.60 


127.60 


100.00 


127-60 


150.00 


140.40 


125.00 


14 


16.00 


30.00 


31 .90 


30.00 


20.00 


50.00 


35.00 


50.00 


50.00 


31 .90 


15 


319.00 


319. PO 


319.00 


319.00 


319.00 


200.00 


191 .40 


350.00 


204.30 


321 .90 


16 


765.60 


765.60 


765.60 


765.60 




574.20 


574.20 


574.20 


574.20 


574.20 


17 


13.00 


13.20 


12.80 


12.00 


13.20 


13.20 


13.20 


13.20 


13.20 


13.20 


18 


625.00 


638.00 


625.00 


625.00 


625.00 


600.00 


650.00 


700.00 


750.00 


600.00 


19 


250.00 


250.00 


250.00 


250.00 


250.00 


319.00 


319.00 


300.00 


300.00 


3 1 9 . 00 


20 


25.00 


25.00 


25.00 


25.00 


20.00 


31 .90 


25.00 


31 .90 


25.00 


25.00 


21 


270.00 


270.00 


300.00 


270.00 


270-00 


300.00 


300.00 


300.00 


319.00 


300.00 


22 


497.60 


497.60 


446.60 


4g7.60 


497.60 


450.00 


500.00 


495.00 


510.40 


446.60 


23 


280.00 


287. 10 


225.20 


287.00 


287. 10 


3 1 . 00 


319.00 


300.00 


287.10 


287. 10 


24 


50.00 


50.00 


50.00 


50.00 


50.00 


44.70 


44.70 


50.00 


45.00 


63.80 


25 


15.00 


15.00 


15.00 


15.00 


15.00 


12.80 


12. 80 


19. 10 


19.10 


12.80 


26 


600.00 


600.00 


600.00 


600.00 


600.00 


550.00 


550.00 


638.00 


600.00 


663.50 


27 


446.60 


450.00 


650.00 


446.60 


446.60 


568.00 


574.20 


574.20 


574.20 


640.00 


28 


574.20 


574.20 


574.20 


574.20 


574.20 


565.00 


600.00 


574.20 


574.20 


5 1 . 40 


29 


550.00 


550.00 


550.00 


500 . 00 


550.00 


500.00 


638.00 


600.00 


500.00 


510:40 


30 


15.00 


15.00 


15.00 


15.00 


17.00 


18.0 j 


si 15.00 


1 2 . 00 


16.00 


1 5.00 


31 


20.00 


25.00 


28.10 


32.80 


28.00 


25 . 00 


20.00 


25.50 


25.00 


20.00 


32 


20.00 


25.00 


25.00 


17. 00 


25-00 


20.00 


20.00 


31 .90 


20.00 


20.00 


33 


31 .90 


45.00 


33.70 


35.00 


31 .90 


44.70 


36 . 00 


44.00 


40.00 


33.30 


34 


37.00 


40 . 00 


38.30 


35.00 


37.00 


35.00 


36.00 


44.70 


36.30 


35.00 


35 


15.00 


15.00 


15.00 


15.00 


15.00 


14.00 


1200 


13.00 


19.10 


14.00 


36 


15.00 


15.00 


15.00 


15.00 


15.00 


31 .90 


18.00 


21 .20 


12.00 


12.00 


37 


3.00 


3.00 


3.00 


3.00 


3.00 


3.00 


3.00 


2.50 


2.00 


3.00 


38 


3.00 


3.00 


3.00 


4.00 


4.00 


3.00 


3.00 


3.00 


3.00 


3.00 


39 


9.00 


8.00 


7.50 


7.00 


9.00 


8.00 


7.00 


7.50 


6.00 


7.50 


40 


7.00 


6.00 


5.00 


6.00 


7.00 


6.00 


7.00 


5.00 


5.00 


6.00 


41 


3.00 


3.00 


3.00 


3 . 00 


6.00 


3.00 


3.00 


3.00 


4.00 


3.00 


42 


5.00 


5.00 


5.00 


6.00 


m 8-oo 


5.00 


6.00 


5 . 00 


5.00 


7.00 


43 


3.00 


5.00 


4.00 


3.00 


: ; 6.00 


4.00 


5.00 


5.00 


3.50 


3.00 


44 


6.00 


6.00 


5.00 


6.00 


6.00 


5.00 


5.00 


5.00 


5.00 


6.00 


45 


8.00 


5.25 


5.00 


6.00 


6.00 


7.00 


6.00 


5.00 


5.00 


7.00 


46 


7.00 


7.00 


8.00 


10.00 


8.00 


7.50 


8.0C 


8.00 


10.00 


8.00 


47 


3.00 


3.00 


3.00 


3.00 


4.00 


4.00 


3.00 


4.00 


5.00 


4.00 


48 


19.10 


16.00 


20.00 


19.10 


19.10 


19.10 


18.00 


19.10 


19.10 


20.00 


49 


44.70 


44.70 


44.70 


44.70 


44.70 


38.50 


40.00 


51.00 


50.00 


51.00 


50 



109 



1977 PREVAILING CHARGE SUMMARY DATA 



NATIONWIDE MUTUAL INSURANCE CO. 



OHIO 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD T RAN FUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 -BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



06 

14.00 
30.00 
3.00 
7.70 
12.00 
20.40 
31 .90 



70 
10 



7. 

19. 

575.00 

5 1 . 40 

12.80 

18.00 

127.60 

25.00 

319.00 

765.60 

13.20 

625.00 

250.00 

30.00 

270.00 

497.66 

■275.00 

50.00 

15.00 

600.00 

446.60 

574.20 

550.00 

15.00 

19.10 

25.00 

31 .90 

37.00 

15.00 

15.00 



cc 

00 



7.00 

4.00 

2.50 

5.00 

4.00 

5.00 

6.00 

10.00 

3.00 

19.10 

44.70 



07 

: 12.80 
28.00 
4.00 
7.70 
10.00 
20.00 
31 .90 
8.90 
19.10 
575.00 
510.40 
12.80 
18.00 
127.60 
3 1 . 90 
319.00 
765.60 
13.20 
625.00 
250.00 
22.00 
270.00 
497.60 
287. 10 
50.00 
15.00 
600.00 
446.60 
574.20 
550.00 
12.00 
19. 10 
25.00 
31 .90 
37.00 
15.00 
15.00 
3.00 
3.00 
6.00 
6.00 



00 
00 
00 
00 
00 
00 
00 



15.00 
44.70 



08 

15.00 
25.00 
3-80 
7 . 70 
15.00 
25.00 
35.00 
8.90 
19. 10 
575.00 
510.40 
15.00 
18.00 
127.60 
30.00 
319.00 
765.60 
13.20 
625.00 
250.00 
25.00 
270.00 
497.60 
287.10 
50.00 
15.00 
600.00 
444.60 
574.20 
550.00 
15.30 
19.10 
25.00 
31 .90 
37.00 
15.00 
15.00 
2.00 
3.00 
5.00 
10.00 
2.00 
6.00 
5.00 
5.00 
4.00 
8.00 
3.00 
19. 10 
44.70 



09 

13.00 
25.50 
3.00 
7 . 70 
10.00 
19.10 
25.00 
7.70 
19.90 
575.00 
510.40 
15.00 
18.00 
127.60 
19. 10 
319.00 
765.60 
13.20 
625.00 
250.00 
25.00 
270.00 
497.60 
287. 10 
50.00 
15.00 
600 . 00 
446.60 
574.20 
550 . 00 
15.00 
19.10 
25.00 
3 1 . 90 
37.00 
15.00 
15.00 



00 
00 
00 



6.25 
2.00 
4.00 
4.00 
5.00 
7.00 
8.00 
3.00 
20.00 
44.70 



10 

18-00 
35.00 
5.10 
10.00 
15.00 
20.00 
35.00 
10.00 
19. 10 
575.00 
5 1 . 40 
16.60 
18.00 
127.60 
1 5 . 00 
319.00 
765.60 
13.20 
625.00 
.250.00 
15.00 
270.00 
497.60 
287. 10 
50.00 
15.00 
600.00 
613.00 
547.20 
550.00 
15.30 
25.00 
25.00 
31 .90 
37.00 
15.00 
15.00 
3.00 
3.90 
7.20 
5.00 
3.00 
6.00 
3-00 
4.00 
4.00 
8.00 
3.00 
19.10 
44.70 



06 

16.00 
38.30 
2.00 
8.90 
15.00 
38.30 
25.00 
10.20 
27.50 
594.00 
550.00 
18.00 
12.80 
126.70 
44.70 
191 .40 
574.20 
13.20 
6 1 2 . 00 
300.00 
40.00 
300.00 
493.00 
306.00 
31 .90 
12.80 
600.00 
510.40 
574.20 
4 50.00 
9.60 
25 . 50 
23.00 
18.00 
16.00 
14.00 
25.60 
2.50 
2.00 
7.50 
6.00 
2.5Q 
5.00 
3.50 
5.00 
6.00 
8.00 
3.50 
20.00 
51 .00 



07 

15.00 
38.30 
3.80 
8.90 
12.80 
30.00 
38.30 
10.00 
27.50 
446.60 
450.00 
19.10 
12.80 
127.60 
44.70 
191 .40 
574.20 
13.20 
638.00 
300-00 
31 .90 
300.00 
414. 70 
255-20 
63.80 
12.80 
600.00 
510.40 
574.20 
550.00 
6-00 
12-80 
23 - 00 
40.00 
31 .90 
14.00 
23.00 
2-50 



.00 
.50 
,00 



2.00 

8.00 

3.00 

4. 50 

5.00 

10.00 

2-50 

15.00 

51.00 



08 

15-00 
- 50.00 
5.30 
10.00 
18.00 
25.50 
44.70 
10.00 
31 .90 
600-00 
540.00 
15.00 
12.80 
125.00 
40.00 
191 .40 
574.20 
13.20 
525.00 
300.00 
20.00 
300.00 
400.00 
250.00 
50.00 
20.00 
600.00 
510.40 
574.20 
446.60 
7.70 
25.50 
23.00 
40.00 
35.00 
14.00 
23.00 
3.00 
2.00 
7.00 
6.00 
2.00 
4.00 
4 . 00 ■: 
4.00 
7.00 
7.00 
4.00 
18.00 
51 .00 



09 

19.10 
30.00 
3.00 
10.00 
15.00 
31 .90 
31 .90 
10.00 
27.50 
540.00 
638.00 
20.00 
12.80 
127.60 
31 .90 
191 .40 
574.20 
13.20 
540.00 
319.00 
25.00 
300.00 
446.60 
236.10 
35.00 
15.30 
500.00 
510.40 
574.20 
510.30 
15.00 
20.00 
23.00 
31 .00 
31 .00 
14.00 
15.00 
5.00 
2.50 
5.00 
5.00 
4.00 
00 
00 
00 
00 
00 
00 



10 



20.00 
51 .00 



20.00 
38.30 
5.30 
12.00 
15.00 
31 .90 
40.00 
12.00 
20.00 
574.20 
600.00 
15.30 
12.80 
127.60 
50.00 
300.00 
574.20 
13.20 
638.00 
300.00 
31 .90 
300.00 
5 1 . 00 
287. 10 
50.00 
16.00 
600.00 
638.00 
574.20 
574.20 
12.00 
21 .70 
21.70 
35.00 
38.00 
15.00 
23.00 
2.50 
2.00 
7.00 
5.00 
2.00 
5.00 
4.00 
3.50 
5.00 
6.00 
3.00 
19. 10 
30.00 



01 
02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



110 



1977 PREVAILING CHARGE SUMMARY DATA NATIONWIDE MUTUAL INSURANCE CO. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



OHIO 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



11 



12 



13 



14 



15 



11 



12 



13 



14 



15 



15.00 


15.00 


15.00 


15.00 


1 2 . 80 


19.10 


15.00 


19.10 


19.10 


15.00 


01 


35.00 


30.00 


30-00 


30.00 


30.00 


35.00 


35.00 


40.00 


50.00 


30.00 


02 


2 . 00 


3.00 


3.00 


3 . 00 


:;&; 5.00 


5.0Q 


3.00 


5. 10 


5.00 


2.00 


03 


10.00 


7.70 


7.70 


7.70 


7-70 


:> 10.00 


V 8.90 


12. DO 


10.00 


8.90 


04 


15.00 


10.00 


12.80 


12.00 


12.50 


15.00 


15.00 


19.10 


12.80 


10.00 


05 


19.10 


25.00 


20.00 


19.10 


19. 10 


25.50 


25.50 


31 .90 


30.00 


35.00 


06 


50.00 


35.00 


30.00 


40.00 


30.00 


50.00 


44.70 


60.00 


51 .00 


38.30 


07 


10.00 


8.90 


7.70 


7.70 


8.90 


10.20 


11 .50 


15.00 


12.00 


10.00 


08 


19.10 


19.10 


19.10 


25.00 


19.10 


25.00 


27.50 


26.00 


20.00 


25.00 


09 


575.00 


575.00 


595.00 


575.00 


575.00 


525.00 


600-00 


600.00 


486.00 


500.00 


10 


510.40 


510.40 


400.00 


510.40 


510.40 


574.20 


638.00 


625-00 


585.00 


720.00 


11 


19.10 


15.00 


1 2 . 80 


19. 10 


1 5 . 00 


19.10 


10.20 


15.00 


19. 10 


19.10 


12 


25.00 


18.00 


18.00 


18.00 


18.00 


12.80 


12.80 


12.80 


. 12.80 


12.80 


13 


150.00 


127.60 


127.60 


127.60 


127.50 


127.60 


127.60 


127.60 


127.60 


127.70 


14 


30.00 


31 .90 


30.00 


25.00 


25.00 


44.70 


44.70 


27.00 


44.70 


35.00 


15 


319.00 


319.00 


319.00 


319.00 


3 1 9 . 00 


191 .40 


191 .40 


191 .40 


191 .40 


1 9 1 . 40 


IS 


765.60 


765.60 


765.50 


765.60 


765.60 


574.20 


574.20 


574.20 


574.20 


574.20 


17 


13.20 


25.00 


13.20 


13.20 


13.20 


13.20 


13.20 


13.20 


13.20 


13.20 


18 


600.00 


625.00 


625.00 


6 1 4 . 00 


625.00 


638.00 


476.00 


600.00 


500.00 


574.20 


19 


250.00 


250.00 


250.00 


250 . 00 


250.00 


300.00 


300.00 


300.00 


300.00 


300.00 


20 


25.50 


25.00 


19.10 


19. 10 


19. 10 


30.00 


20.00 


20.00 


25.00 


20.00 


21 


270.00 


270.00 


270.00 


270.00 


270.00 


300.00 


300.00 


300.00 


191 .40 


200.00 


22 


450.00 


497.60 


500.00 


497.60 


497.60 


475.00 


375.00 


400.00 


435.20 


450.00 


23 


225.20 


287.10 


287.10 


287.10 


265.00 


: 319.00 


252.00 


255.20 


270.00 


287.10 


24 


50.00 


30.00 


50.00 


50.00 


50.00 


75-00 


25.00 


50.00 


60.00 


35.00 


25 


15.00 


15.00 


15.00 


15.00 


15.00 


15.00 


24.50 


15.00 


15.00 


12.80 


26 


600.00 


600.00 


600.00 


600 . 00 


600.00 


600.00 


600.00 


600.00 


525.00 


540.00 


27 


466.60 


490.00 


446.60 


446.60 


446.60 


613.50 


560.00 


612.50 


495.00 


600.00 


28 


574.20 


574.20 


574.20 


574.20 


574.20 


625.00 


574.20 


574.20 


574.20 


574.20 


29 


550.00 


550 . 00 


550.00 


550.00 


550.00 


550.00 


446.60 


550.00 


510.40 


478.50 


30 


20.00 


1 5 . 30 


15.00 


15.00 


15.00 


21.70 


9.60 


1 3 . 00 


10.00 


10.00 


31 


28.10 


19. 10 


19.10 


18.00 


23.50 


20.00 


25.50 


26.60 


20.00 


25.00 


32 


21 .00 


25.00 


25.00 


25.00 


25-00 


23.00 


23.00 


18.00 


23.00 


23.00 


33 


31.90 


31 .90 


31.90 


31 .90 


35.00 


50.60 


40.00 


38.00 


40.00 


25.00 


34 


37.00 


37.00 


37.00 


37.00 


51 .50 


43.75 


38.30 


32.00 


38.30 


25.00 


35 


15.00 


!5.00 


15.00 


15.00 


15.00 


12.80 


14.50 


12.80 


14.00 


10.00 


36 


15.00 


15.00 


15.00 


15.00 


15.00 


19.10 


17.00 


23.00 


15.00 


23.00 


37 


5.00 


2.00 


5.00 


3.00 


3.00 


3.00 


3.00 


3.00 


3.00 


2.00 


38 


5.00 


3.00 


3.00 


3.00 


3.00 


3.00 


2.00 


2.00 


3.00 


2.00 


39 


8.00 


8.00 


8.50 


6.00 


6 . 00 


7.00 


10.00 


7.00 


8.00 


7.00 


40 


6.50 


5.00 


7.50 


6.00 


6.00 


6.00 


6.00 


6.00 


5.00 


5.00 


41 


3.00 


3.00 


3.00 


3.00 


3.00 


5.00 


2.00 


2.00 


3 . 00 


2.00 


42 


5.00 


8.00 


5.00 


4 . 00 


5.00 


5.00 


5.00 


■ 4.50 


5.00 


4 . 00 


43 


5.00 


3.00 


5.00 


3.00 


5.00 


3.00 


3.00 


4.00 


3.00 


3.00 


44 


5.20 


4.00 


8.00 


6 . 00 


6.00 


5.00 


4.00 


5.00 


5.00 


5.00 


45 


6.00 


5.00 


6.00 


6.00 


5.00 


6.00 


6-00 


5.00 


3.50 


5.00 


46 


10.00 


10.00 


8.00 


7.00 


15.00 


10.00 


5.00 


8.00 


7.00 


6.00 


47 


3.00 


3.00 


3.00 


3.00 


3.00 


4.00 


3.00 


3.00 


3.00 


3.00 


48 


25.00 


20.00 


19.80 


20.00 


20.00 


20.00 


22.00 


20.00 


19. 10 


16.60 


49 


44.70 


44.70 


44.70 


44.70 


44.70 


45.00 


51 .00 


40.00 


51 .00 


51 .00 


50 



111 



OKLAHOMA 



Oklahoma City 01 



Tulsa 02 




Rest of the State 99 

Clinton 03 



Altus 03 



Five Localities: handled by both Aetna and the State Public 
Welfare Commission (10 screens) 



01 - Oklahoma City: Bethany, Del City, Edmond, EL Reno, Midway 

Village, Midwest City, Moore, Nichols Hill, 
Nicoma Park, Norman, Seminole, Shawnee, 
Spencer, The Village, Valley Brook, Warr 
Acres, Yukon 

02 - Tulsa: Bixby, Broken Arrow, Claremore, Collinsville , 

Coweta, Jenks, Oakhurst, Owasso, Prattville, 

Sand Springs, Sapulpa, Skiatook, Turley, McAlester, 

Muskogee, Okmulgee, Catoosa 

03 - Ada, Ardmore, Durant, Chickasha, Lawton, Altus, Clinton, Duncan 

04 - Enid, Ponca City, Bartlesville, Stillwater 
99 - All other 

( Locality is determined by the city cited in the 
return address.) 




Durant 03 



Ada 03 



112 



1977 PREVAILING CHARGE SUMMARY DATA 



AETNA LIFE AND CASUALTY 



OKLAHOMA 



LOCALITY DESIGNATION FqR GENERAL PRACTICE 



LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 01 02 

01 INITIAL LIMITED OFFICE VISIT 15.00 11.00 

02 INITIAL COMP OFFICE VISIT 35.00 31.90 

03 MINIMAL OFFICE VISIT 5.10 3-00 

04 ROUTINE BRIEF OFFICE VISIT 7.70 7.70 

05 ROUTINE BRIEF HOME VISIT 12.80 12.80 

06 INITIAL BRIEF HOSPITAL VISIT 25.00 25.00 

07 INITIAL COMP HOSPITAL VISIT 44.70 50.00 

08 ROUTINE BRIEF HOSPITAL VISIT 10-00 10.00 

09 BIOPSY SKIN 20.00 25.00 

10 RADICAL MASTECTOMY 510.40 462.30 

11 REDUCTION OF FRACTURE 701.80 701.80 

12 ARTHOTMY 13.00 12.60 

13 NEEDLE PUNCTURE OF BURSA 16.00 12.80 

14 BRONCHOSCOPY 150.00 150.00 

15 THORACENTESIS 31.90 31.90 

16 CATHETERT-"*TION 350.00 350.00 

17 INSERTION OF PACEMAKER 750.00 750.00 

18 BLOOD TRANFUSION 13.40 13.40 

19 COLECTOMY 551.20 600.00 

20 APPENDECTOMY 255.20 300.00 

21 SIGMOIDOSCOPY 30.00 25.00 

22 HEMORRHOIDECTOMY 206.70 250.00 

23 CHOLECYSTECTOMY 450.00 510.40 

24 REPAIR HERNIA V 255.20 255.20 

25 CYSTOSCOPY 38.30 38.30 

26 DILATION OF URETHRA 14.10 14.10 

27 PROSTATECTOMY 510.40 510.40 

28 ELECTROSECTION OF PROSTATE 600.00 600.00 

29 HYSTERECTOMY 446.60 480.00 

30 EXTRACTION OF LENS 510.40 510.40 

31 X-RAY CHEST 15.00 15.00 

32 X-RAY SPINE 25.00 25.00 

33 X-RAY HIP 19. iO 21 .00 

34 X-RAY STOMACH 40.50 44.70 

35 X-RAY COLON 40.00 44.70 

36 COBALT 19.10 19.10 

37 RADIOTHERAPY 22.00 22.00 

38 HEMOGLOBIN 4.00 3.00 

39 WHITE CELL COUNT 5.00 5.00 

40 COMPLETE BLOOD COUNT 7.00 10.00 

41 CHOLESTERAL BLOOD COUNT 6.00 8.00 

42 HEMATOCRIT 3.00 3.00 

43 PROTHROMBIN 5.25 6.00 

44 SEDIMENTATION RATE 5.00 6.00 

45 BLOOD SUGAR 6.00 7.00 

46 BUN UREA NITRATE 6.00 7.00 

47 PAP TEST 10.00 10.00 

48 URINALYSIS 5.00 5.00 

49 ELECTROCARDIOGRAM 19.10 19.10 

50 ELECTROENCEPHALOGRAM 50.00 50.00 



03 

12.00 

35.00 

5.10 

6.40 

10.00 

19.10 

38.30 

8.90 

19. 10 

5 1 . 40 

701 -80 

12.80 

12.80 

150.00 

31 .90 

350.00 

750.00 

13.40 

600.00 

2eo.oo 

19.10 

250.00 

400.00 

250.00 

38.30 

14.10 

510.40 

600.00 

480.00 

510.40 

15.00 

16.50 

21 .00 

31 .90 

44.70 

19.10 

22.00 

3.00 

3.00 

8.00 

6.00 

2.50 

6.00 

6.00 

6.00 

7.00 

10.00 

4.00 

17.25 

50.00 



04 

. :■ ■ ■ ■ '■: 

10.00 

6.40 

3.00 

7.70 

12.80 

19.10 

44.70 

8.90 

15.30 

510.40 

701 .80 

13.00 

12.80 

150.00 

31 .90 

350.00 

750.00 

13.40 

600.00 

275.60 

35.00 

191 .40 

435.00 

287. 10 

38.30 

14. 10 

5i0.40 

600.00 

480.00 

510.40 

18.00 

25.50 

2 1 • 00 

38.30 

44 . 70 

19. 10 

22.00 



50 
00 



8.00 



00 
25 
00 



5.00 
6.00 
10.00 
10.00 
4.00 
19. 10 
50.00 



99 

10.00 

35.00 

5.00 

6.40 

10.00 

19.10 

35.00 

10.00 

19.10 

446.60 

701 .80 

13.20 

10.00 

1 50 . 00 

25.00 

350.00 

750.00 

13.40 

600.00 

255.20 

25.00 

191 .40 

440.00 

250.00 

38.30 

14. 10 

510.40 

551 .20 

446.60 

510.40 

15.00 

25.00 

21 .00 

48 . 00 

42.00 

19. 10 

22.00 



00 
00 
00 



6.00 



00 
00 
00 
00 
00 



10.00 

4.00 

18.00 

50.00 



01 

20.00 

44.70 

5.90 

10.00 

19.10 

35.00 

50.00 

12.80 

20.70 

638.00 

701 .80 

13.50 

22.00 

1 1 5 . 00 

31 .90 

255.20 

750.00 

13.40 

630.00 

350.90 

25.50 

300.00 

478.50 

310.00 

35.00 

15.00 

574.20 

574.20 

574.20 

500.00 

12.00 

25.40 

21 .25 

38.30 

34.50 

19.10 

22.00 

3.00 

4.00 

8.00 

7.50 

3.50 

5.00 

5.00 

6.00 

7.50 

8.50 

5.50 

18.00 

50.00 



02 

16-75 

56.00 

4.00 

12.00 

19. 10 

35.00 

56.00 

12.80 

35.00 

630.00 

701 .80 

18.00 

22.00 

103.40 

25.00 

350.00 

750.00 

13.40 

650.00 

382.80 

25.00 

240.00 

500.00 

315.00 

38.30 

14. 10 

714.60 

605.00 

600.00 

510.40 

16.00 

25.00 

21.25 

42.00 

38.30 

19. 10 

19. 10 

3.00 

4.50 

7.50 

7.00 

4.50 

6.00 

4.30 

6.00 

7.00 

10.00 

4.00 

19. 10 

50.00 



03 

15.00 

51 .00 

5.00 

8.50 

12.50 

25.00 

51 .00 

12.00 

25.00 

550.00 

701 .80 

15.30 

15.00 

103.40 

25.00 

255.20 

750.00 

13.40 

6 1 5 . 00 

3 1 9 . 00 

20.60 

220.50 

459.40 



10 
90 



287. 

31 

13.20 

638.00 

510.40 

550.00 

510.40 

1 2 . 00 

15.30 

21 .25 

35.00 

38.00 

19. 10 

22.00 

2.50 

4.00 

9.50 

7.00 

2.00 

5.00 

4.00 

6.00 

7.00 

10.00 

4.00 

15.00 

50.00 



04 

15.00 

50.00 

6.00 

7.70 

19. 10 

25.50 

50.00 

12.00 

25.00 

606.10 

701 .80 

18.00 

22.00 

103.40 

25.00 

255.20 

750.00 

13.40 

575.00 

300.00 

30.00 

287. 10 

446.60 

300.00 

40.00 

12.80 

638.00 

561 .40 

450.00 

500.00 

17.50 

25.00 

21 .25 

44.70 

51 .00 

19. 10 

22.00 

2.00 

2.50 

8.00 



00 
00 
00 
00 



5.00 
7.00 
8.50 
4.00 
19. 10 
50.00 



99 

15.30 

31 .90 

5.10 

6.40 

10.00 

30.00 

44.70 

10.20 

25.00 

482.30 

701 .80 

18.50 

22.00 

120.00 

25.00 

255.20 

750.00 

13.40 

6 1 2 . 50 

300.00 

19.10 

287. 10 

446.60 

280.00 

38.30 

14. 10 

638.00 

574.20 

574.20 

510:40 

15.00 

25.00 

21.25 

40.00 

38.00 

19. 10 

22.00 

2.50 

3.00 

5.90 

7.25 

2.50 

8.00 



60 
60 
00 



12.00 

4.00 

15.00 

50.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



113 



1977 PREVAILING CHARGE SUMMARY DATA DEPT. OF INST.. SOCIAL AND REHAB. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 
PROCEDURE DESCRIPTION 01 02 03 04 99 



OKLAHOMA 
LOCALITY DESIGNATION FOR SPECIALIST 



01 



02 



03 



04 



99 



01 


INITIAL LIMITED OFFICE VISIT 


15.00 


11 .00 


1 2 . 00 


10 


00 


10.00 


20.00 


16.75 


15.00 


15.00 


15.30 


01 


02 


INITIAL COMP OFFICE VISIT 


35. CT 


31 .90 


35.00 


6 


40 


35.00 


44.70 


56.00 


- 51 .00 


50.00 


31 .90 


02 


03 


MINIMAL OFFICE VISIT 


5. 10 


3.00 


5.10 


3 


00 


5.00 


5.90 


4.00 


5.00 


6.00 


5. 10 


03 


04 


ROUTINE BRIEF OFFICE VISIT 


7.70 


7.70 


6.40 


7 


70 


6.40 


10.00 


12.00 


8.50 


7.70 


6.40 


04 


05 


ROUTINE BRIEF HOME VISIT 


12.80 


12.80 


10.00 


12 


80 


10.00 


19.10 


19. 10 


12.50 


19. 10 


10.00 


05 


06 


INITIAL BRIEF HOSPITAL VISIT 


25.00 


25.00 


19.10 


19 


10 


19. 10 


35.00 


35.00 


25.00 


25.50 


30.00 


06 


07 


INITIAL COMP HOSPITAL VISIT 


44.70 


50.00 


38.30 


44 


70 


35.00 


50.00 


56.00 


51 .00 


50.00 


44.70 


07 


08 


ROUTINE BRIEF HOSPITAL VISIT 


10.00 


10.00 


8.90 


8 


90 


10.00 


12.80 


12.80 


12.00 


12.00 


10.20 


08 


09 


BIOPSY SKIN 


20.00 


25.00 


19. 10 


15 


30 


19. 10 


20.7o 


35.00 


25.00 


25.00 


25.00 


09 


10 


RADICAL MASTECTOMY 


510.40 


482.30 


510.40 


510 


40 


446.60 


638.00 


630.00 


550.00 


606. 10 


482.30 


10 


11 


REDUCTION OF FRACTURE 


701 .80 


701 -80 


701 .80 


701 


80 


701 .80 


701 .80 


701 .80 


701 .80 


701. eo 


701 .80 


11 


12 


ARTHOTMY 


13.00 


12.80 


12.80 


13 


00 


13.20 


13.5Q 


18.00 


15.30 


18.00 


18.50 


12 


13 


NEEDLE PUNCTURE OF BURSA 


16.00 


12.80 


12.80 


12 


80 


10-00 


22.00 


22.00 


15.00 


22.00 


22.00 


13 


14 


BRONCHOSCOPY 


150.00 


1 50 . 00 


1 50 . 00 


150 


00 


1 50 . 00 


115.00 


103.40 


103.40 


103.40 


1 20.00 


14 


15 


THORACENTESIS 


3 1 . 90 


31 .90 


31 -90 


31 


90 


25.00 


31 .90 


25.00 


25.00 


25.00 


25.00 


15 


16 


CATHETERIZATION 


350.00 


350.00 


350.00 


350 


00 


350.00 


255.20 


350.00 


255.20 


255.20 


255.20 


16 


17 


INSERTION OF PACEMAKER 


750.00 


750. CO 


750.00 


750 


00 


750.00 


750.00 


750.00 


750.00 


750.00 


750.00 


17 


18 


BLOOD T RAN FUSION 


13.40 


13.40 


13.40 


13 


40 


13.40 


13.40 


13.40 


13.40 


13.40 


13.40 


18 


19 


COLECTOMY 


551 .20 


600.00 


600.00 


600 


00 


600.00 


630.00 


650.00 


6 1 5 . 00 


575.00 


612.50 


19 


20 


APPENDECTOMY 


255.20 


300.00 


280.00 


275 


60 


255.20 


350.90 


382.80 


319.00 


300.00 


300.00 


20 


21 


SIGMOIDOSCOPY 


30.00 


25.00 


19.10 


35 


00 


25.00 


25.50 


25.00 


20.60 


30.00 


19.10 


21 


22 


HEMORRHOIDECTOMY 


206.70 


250.00 


250.00 


191 


40 


191 .40 


300.00 


240.00 


220.50 


287. 10 


287.10 


22 


23 


CHOLECYSTECTOMY 


450.00 


510.40 


400.00 


435 


00 


440.00 


478.50 


500.00 


459.40 


446.60 


446.60 


23 


24 


REPAIR HERNIA 


255.20 


255.20 


250.00 


287 


10 


250.00 


3 1 . 00 


315.00 


287.10 


300.00 


280.00 


24 


25 


CYSTOSCOPY 


38.30 


38.30 


38.30 


38 


30 


38.30 


35.00 


38.30 


31 .90 


40.00 


38.30 


25 


26 


DILATION OF URETHRA 


14.10 


14.10 


14.10 


14 


10 


14.10 


15.00 


14. 10 


13.20 


12.80 


14. 10 


26 


27 


PROSTATECTOMY 


510.40 


510.40 


510.40 


510 


40 


5 1 . 40 


574.20 


714. 60 


638.00 


638.00 


638.00 


27 


28 


ELECTROSECTION OF PROSTATE 


600.00 


600.00 


600.00 


600 


00 


,551 .20 


574.20 


605.00 


510.40 


561 .40 


574.20 


28 


29 


HYSTERECTOMY 


446.60 


480.00 


480.00 


480 


00 


446.60 


574.20 


600.00 


550.00 


450.00 


574.20 


29 


30 


EXTRACTION OF LENS 


510.40 


510.40 


510.40 


510 


40 


510.40 


500.00 


510.40 


510.40 


500.00 


510.40 


30 


31 


X-RAY CHEST 


1 5 . 00 


15.00 


15.00 


18 


00 


15.00 


12.00 


16-00 


12.00 


17.50 


15.00 


31 


32 


X-RAY SPINE 


25.00 


25.00 


16.50 


25 


50 


25.00 


25.40 


25.00 


15.30 


25.00 


25.00 


32 


33 


X-RAY HIP 


19.10 


21 .00 


21 .00 


21 


00 


■ ' 21 .00 


21 .25 


21 .25 


21 .25 


21.25 


21.25 


33 


34 


X-RAY STOMACH 


40.50 


44.70 


31 .90 


"%■ 38 


30 


48.00 


38.30 


42.00 


35.00 


44.70 


40.00 


34 


35 


X-RAY COLON 


40.00 


44.70 


44.70 


44 


70 


42.00 


34.50 


38.30 


38.00 


51 .00 


38.00 


35 


36 


COBALT 


19.10 


19.10 


19.10 


19 


10 


19.10 


19.10 


19.10 


19.10 


19. 10 


19. 10 


36 


37 


RADIOTHERAPY 


22.00 


22.00 


22.00 


22 


00 


22.00 


22.00 


19. 10 


22.00 


■22.00 


22.00 


37 


38 


HEMOGLOBIN 


4.00 


3.00 


3.00 


3 


50 


4.00 


3.00 


3.00 


2.50 


2.00 


2.50 


38 


39 


WHITE CELL COUNT 


5.00 


5.00 


3.00 


3 


00 


4.00 


4.00 


4.50 


4.00 


2.50 


3.00 


39 


40 


COMPLETE BLOOD COUNT 


7.00 


10.00 


8.00 


8 


00 


7.00 


8.00 


7.50 


9 . 50 


8.00 


5.90 


40 


41 


CHOLESTERAL BLOOD COUNT 


6.00 


8.00 


6.00 


7. 


00 


. 6 . 00 


7.50 


7.00 


7.00 


5.00 


7.25 . 


41 


42 


HEMATOCRIT 


3.00 


3 . 00 


2.50 


3. 


25 


3.00 


3.50 


4.50 


2.00 


3.00 


2.50 


42 


43 


PROTHROMBIN 


5.25 


6.00 


6.00 


5 


00 


6.00 


5.00 


6.00 


5.0O 


5.00 


8 . 00 


43 


44 


SEDIMENTATION RATE 


5.00 


6.00 


6.00 


5 


00 


5.00 


5.00 


4.30 


4 . 00 


5.00 


:: 4.60 


44 


45 


BLOOD SUGAR 


6.00 


7 . 00 


6.00 


6. 


00 


6.00 


6.00 


6.00 


6.00 


5.00 


6.60 


45 


46 


BUN UREA NITRATE 


6.00 


7.00 


7.00 


10. 


00 


6.00 


7.50 


7.00 


7.00 


7.00 


7.00 


46 


47 


PAP TEST 


10.00 


10.00 


10.00 


10. 


00 


10.00 


8.50 


10.00 


10.00 


8.50 


12.00 


47 


48 


URINALYSIS 


5.00 


5.00 


4.00 


4 . 


00 


4.00 


5.50 


4.00 


4.00 


4.00 


4.00 


48 


49 


ELECTROCARDIOGRAM 


19.10 


19.10 


17.25 


19. 


10 


18.00 


18.00 


19. 10 


15.00 


19.10 


15.00 


49 


50 


ELECTROENCEPHALOGRAM 


50.00 


50.00 


50.00 


50. 


00 


50.00 


50.00 


50.00 


50.00 


50.00 


50.00 


50 



liU 



OREGON 



* 






- 



115 



OREGON 




Five Localities: 

01 - Portland - Aloha, Battin, Beaverton, Cedar Hills, Collins View, 

Powellhurst, Raleigh Hills, RLverdale, Robin Wood, Sandy- 
Sylvan, Errol Heights, Garden Home, Gilbert, Gladstone, 
Glendoveer, Gresham, Hazelwood, Hillsboro, Jennings Lodge, 
Kelly Butte, Lake Oswego, Marlene Village, Metzger, Milwaukee, 
Oakgrove, Oregon City, Parkrose, Tigard, West Linn, West 
Portland, West Portland Park, West Powellhurst, West Slope 
/ 

02 - Eugene - Glenwood, River Road, Santa Clara, Springfield, 

Veneta, Coos Bay and Eoseburg 



03 - Salem - Four Corners, Hayesville, Keizer, Corvallis, Albany, Lebanon 

12" Medford, Klamath Falls, Grant's Pass 

99 - Rest of State 

(Locality determined by city cited in return address.) 

116 



1977 PREVAILING CHARGE SUMMARY DATA 



AETNA LIFE AND CASUALTY 



OREGON 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 



01 



02 



03 



12 



99 



01 



02 



03 



12 



99 






01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



12.50 


12.80 


1 2 . 00 


12.80 


12.00 


12.50 


12.80 


12.80 


12.00 


12.80 


01 


44.70 


44.70 


44.70 


25.00 


42.00 


S 1 . CO 


51 .00 


44.70 


38.30 


44.70 


02 


6.40 


5.10 


5.00 


6.40 


5.10 


6. OQ 


5.10 


5.00 


5.10 


6.00 


03 


9.60 


10.20 


8.90 


8.90 


8.00 


11 .00 


10.20 


10.00 


10.00 


10.00 


04 


15.00 


18.00 


19. 10 


15.00 


12.80 


19. 10 


19.10 


15.00 


15.30 


18.00 


05 


19.10 


19.10 


19.10 


19.50 


19. 10 


19. 10 


19. 10 


19. 10 


19.10 


19. 10 


06 


44.70 


44.70 


44.70 


49.80 


44.70 


51 .00 


51 .50 


50.50 


40.00 


44.70 


07 


9.60 


9.60 


8.90 


8.90 


8.90 


12.00 


12.80 


1 1 .00 


10.00 


10.90 


08 


25.00 


9.60 


25.50 


20.00 


25.50 


26.00 


19. 10 


23.40 


12.80 


22.75 


09 


138.40 


535.90 


535-90 


574.20 


535.90 


638.00 


612.00 


510.40 


597.20 


574.20 


10 


714.60 


714.60 


714.60 


714.60 


714.60 


765.60 


714.60 


714.60 


714.60 


7 1 4 . 60 


11 


15.80* 


14.60* 


15.60* 


15.80' 


15.40* 


18.60* 


16.80* 


16.80* 


18.20* 


17.60* 


12 


1 5 . 80 * 


14.60* 


15.60* 


15.80* 


15.40* 


16.80* 


17.40* 


1 4 . 60* 


15.80* 


15.80* 


13 


135.00 


135.00 


135.00 


135.00 


135.00 


127.60 


116.80 


108.50 


127.60 


146.70 


14 


25.50 


25.00 


25.00 


25.00 


25.00 


40.00 


23.40 


23.40 


35.00 


25.50 


15 


255.20 


255.20 


255.20 


255.20 


255.20 


255.20 


255.20 


255.20 


255. 20 


255.70 


16 


660.00 


660.00 


660.00 


660.00 


660.00 


660.00 


660.00 


660.00 


660.00 


660.00 


17 


15.80* 


14.60* 


15.60* 


15.80- 


15.40* 


16.80* 


17.40* 


14.60* 


15.80* 


15.80* 


18 


638.00 


638.00 


638.00 


638.00 


600.00 


663.50 


622.70 


574.20 


612.50 


594.00 


19 


319.00 


3 1 9 . 00 


319.00 


319.00 


319.00 


357.30 


338. 10 


338. 10 


311 .30 


308.75 


20 


23.70* 


21 .90* 


23-40* 


23.70* 


23.10* 


25.70* 


26. 10* 


21 .90* 


23. 70* 


23.70* 


21 


250.00 


250.00 


250.00 


250.00 


250.00 


245.00 


233.50 


2 1 . 50 


233.50 


245.00 


22 


446.60 


459.40 


459.40 


459.40 


459.40 


510.40 


522.00 


446.60 


458.20 


465.00 


23 


275.00 


272.40 


287. 10 


268-00 


287.10 


319.00 


315.00 


255.20 


268.00 


297.00 


24 


39.50* 


36.50* 


39.00* 


39.50* 


38.50* 


39.00* 


35.00* 


37.50* 


39.00* 


39.00* 


25 


23.70* 


21 .90* 


23.40* 


23.70* 


23.10* 


23.40* 


21 . 00* 


22.50* 


23.40* 


23.40* 


26 


612.50 


612.50 


6 1 2 . 50 


612.50 


612.50 


612.50 


561 .40 


612.50 


612.50 


612.50 


27 


632.90 


632.90 


632.90 


632.90 


632.90 


663.50 


561 .40 


632.90 


612.50 


612.50 


28 


574.20 


574.20 


574.70 


574.20 


574.20 


574.20 


612.50 


574.70 


574.20 


574.20 


29 


630.00 


630.00 


630.00 


630 . 00 


630.00 


600.00 


600.00 


638.00 


612.50 


606. 10 


30 


15.00 


1 6 . 00 


13.00 


13.20 


15.00 


12.80 


13.50 


15.30 


15.30 


15.30 


31 


23.00 


23.10 


23.50 


21 . 10 


19.25 


23.00 


21 . 10 


25.50 


25.50 


25.50 


32 


20. 00 


22.30 


22.30 


22.30 


21 .70 


22.00 


22.00 


22.00 


22.00 


22.00 


33 


45. go 


41 .50 


48-50 


45.90 


44.70 


44.70 


48.50 


48.50 


48.50 


48.50 


34 


40.00 


28.70 


43.00 


40.00 


39.50 


44.70 


35. 10 


44.70 


35.10 


44. 70 


35 


21.10 


21 - "O 


21 .10 


21 . 10 


21 . 10 


21 . 10 


21.10 


21 . 10 


21.10 


21 . 10 


36 


36.00 


26.00 


26.00 


26.00 


26.00 


26.00 


26.00 


26.00 


26.00 


26-00 


37 


3.50 


3.50 


3.50 


4.00 


3.00 


7.50 


3.75 


3.00 


3.00 


3.00 


38 


3.50 


3.00 


3.50 


3.00 


2.50 


3.25 


3.75 


3.00 


3.00 


3.00 


39 


8.50 


12.00 


8.50 


8.50 


8.50 


7.5Q 


10.50 


8.40 


9.30 


9.50 


40 


7.00 


6.25 


7.50 


6.50 


7.50 


6.5Q 


.9.50 


7.00 


7.70 


7.50 


41 


3.50 


3.00 


3.00 


2 . 50 


3.50 


3.50 


3.50 


2.80 


3.00 


3.00 


42 


7.00 


8.00 


5.00 


6.00 


6.40 


6 . 00 


6.80 


6 . 00 


5.50 


5.60 


43 


3.50 


6.50 


4.20 


4.50 • 


4.00 


4.00 


5.00 


3.00 


4.90 


5.30 


44 


7.00 


9.00 


6.00 


7.50 ' 


6.50 


6.00 


9-00 


6.00 


7.00 


7.00 


45 


7.00 


10.00 


6.00 


8.00 


7.70 


7.00 


10.00 


5.50 


7.70 


7.70 


46 


8.25 


10.50 


7.00 


9.00 


10.00 


8.00 


10.00 


10.75 


8.00 


8.00 


47 


4.00 


5.50 


4.20 


4.50 


4.00 


4.00 


5.50 


4.50 


4.50 


4.00 


48 


20.00 


19.10 


21 .00 


22.50 


19.50 


19.10 


22.75 


47.90 


20.00 


20.00 


49 


51 .00 


51 .00 


51 .00 


51 .00 


51 .00 


50.00 


47.90 




47.90 


47.90 


50 



117 



PENNSYLVANIA 



. 







AllENTOWN BETHlEHEM-EASTON 



Four Localities: 

01 - Areas of Medical Schools/Specialty Hospitals 

02 - Major Metropolitan Areas 

03 - Lesser Metropolitan Areas 
0l| - Urban Areas 

Note exceptions for Pittsburgh and Philadelphia in Appendix A 



118 



1977 PREVAILING CHARGE SUMMARY DATA 



PENNSYLVANIA B/S 



PENNSYLVANIA 







LOCALITY 


DESIGNAT 


ION FOR 


GENERAL PRACTICE 


LOCALITY 


DESIGNATION FOB 


SPECI 


PROCEDURE DESCRIPTION 




1 


2 


3 


4 


1 


2 


3 


4 


01 INITIAL LIMITED OFFICE 


VISIT 


12.00 


12.00 


10.00 


10.00 


15. 00 


15.00 


13.00 


1 1 . 00 


02 INITIAL COMP OFFICE 


VISIT 


31 .90 


35 . 00 


20.00 


25.00 


50.00 


50.00 


35.00 


35.00 


03 MINIMAL OFFICE VISIT 




















04 ROUTINE BRIEF OFFICE VISIT 


10.00 


9.00 


8.00 


8.00 


1 1 .00 


10.00 


■: 10.00 


8.00 


05 ROUTINE BRIEF HOME VISIT 


12.80 


12.80 


12.00 


10.00 


12.80 


12.80 


12.80 


10. 00 


06 INITIAL BRIEF HOSPITAL 


VISIT 


35.00 


31 .90 


25.00 


30- 00 


35.00 


35.00 


35.00 


30.00 


07 INITIAL COMP HOSPITAL 


VISIT 


44.70 


35.00 


38.30 


30.00 


50.00 


50.00 


44.70 


40.00 


08 ROUTINE BRIEF HOSPITAL 


VISIT 


10.00 


10.00 


8.00 


7.00 


12.00 


12.00 


12.00 


8.00 


09 BIOPSY SKIN 




















10 RADICAL MASTECTOMY 




600.00 


574.20 


574.20 


574.20 


600.00 


600.00 


510.40 


500.00 


11 REDUCTION OF FRACTURE 




600.00 


600.00 


600.00 


600.00 : 


800. Oo 


750.00 


587. OQ 


638.00 


12 ARTHOTMY 




15.00 


20.00 


19. 10 


18.00 


20.00 


20.00 


20.00 


15.00 


13 NEEDLE PUNCTURE OF BURSA 


















14 BRONCHOSCOPY 




150.00 


150.00 


150.00 


150.00 


108.00 


127.60 


125.00 


125.00 


15 THORACENTESIS 




30.00 


30.00 


25.00 


30.00 


85.00 


50.00 


63.80 


50.00 


16 catheter:za t :on 




500.00 


500. CC 


500.00 


500 . 00 


550.00 


500.00 


575.00 


525.00 


17 INSERTION OF PACEMAKER 




500.00 


500.00 


500.00 


500 . 00 


500.00 


500.00 


500.00 


500. 00 


18 BLOOD TRANFUSION 




22.00 


22.00 


10.00 


12.00 


10.00 


10.00 


10.00 


10.00 


19 COLECTOMY 




400.00 


400.00 


400.00 


400.00 


800.00 


765. 60 


600.00 


600.00 


20 APPENDECTOMY 




240.00 


240.00 


240.00 


175.00 


3 1 9 . Oo 


287. 10 


268.00 


255.20 


21 SIGMOIDOSCOPY 




25.00 


20.00 


25.00 


25.00 


40.00 


31 .90 


31 . 90 


30.00 


22 HEMORRHOIDECTOMY 




150.00 


150.00 


150.00 


150.00 


255.20 


255.20 


2 1 . 50 


200.00 


23 CHOLECYSTECTOMY 




382.80 


400.00 


350.00 


350.00 


510. 4Q 


446.60 


446.60 


400 . 00 


24 REPAIR HERNIA 




255.20 


255.20 


175.00 


234.00 


319.00 


319.00 


255.20 


250.00 


25 CYSTOSCOPY 




63.80 


63.80 


63.80 


50.00 


55.00 


55.00 


55.00 


45.00 


26 DILATION OF URETHRA 




12.80 


19.10 


12.80 


8.00 


17.00 


15.00 


1 1 .00 


10.00 


27 PROSTATECTOMY 




560.00 


560.00 


560.00 


560.00 


638.00 


638.00 


480. 00 


520. 00 


28 ELECTROSECTION OF PROSTATE 


600.00 


600.00 


600.00 


600 . 00 


605.00 


600.00 


561 .40 


560.00 


29 HYSTERECTOMY 




446.60 


478.50 


446.60 


446.60 


574.20 


574.20 


500.00 


500. 00 


30 EXTRACTION OF LENS 




450.00 


510.40 


574.20 


542.30 


600.00 


574.20 


500.00 


550.00 


31 X-RAY CHEST 




25.00 


25.00 


20.00 


25.00 


27.00 


26.00 


22.00 


20.00 


32 X-RAY SPINE 




45.00 


35.00 


44.70 


44.70 


44.70 


40.00 


44.70 


35.00 


33 X-RAY HIP 




20.00 


25.00 


25.00 


25.00 


25.50 


20.00 


20.00 


15.00 


34 X-RAY STOMACH 




40.00 


50.00 


40.00 


40 . 00 


60.00 


55.00 


50.00 


44.70 


35 X-RAY COLON 




35.00 


40.00 


40.00 


40.00 


57.40 


44. 70 


44.70 


35.00 


36 COBALT 




25.00 


23.60 


24.90 


22.70 


37.50 


20.00 


20.00 


10.00 


37 RADIOTHERAPY 




25.00 


25.00 


25.00 


25.00 


25.00 


25.00 


16.00 


20.00 


38 HEMOGLOBIN 




3.00 


3.00 


2.50 


2.00 


3.00 


3.00 


3.00 


2. 00 


39 WHITE CELL COUNT 




2.50 


3.80 


1.50 


3.00 


2.00 


3.00 


3.00 


3.00 


40 COMPLETE BLOOD COUNT 




8.00 


8.00 


6.00 


6.50 


7.50 


7.50 


7.00 


6.00 


41 CHOLESTERAL BLOOD COUNT 




7.00 


7.00 


5.00 


5.00 


6.00 


6.00 


6.00 


5.00 


42 HEMATOCRIT 




3.00 


3.00 


3.00 


2.50 


3.00 


3.00 


2.50 


3.00 


43 PROTHROMBIN 




7.00 


6.00 


5.00 


5.00 


5 . 00 


6.00 


5.00 


4.00 


44 SEDIMENTATION RATE 




■:•• 5.00 


5.00 


4.00 


4-00 


5.00 


5. 00 


5.00 


6.00 
5.00 


45 BLOOD SUGAR 




5.00 


6.00 


5.00 


5.00 


5.00 


5.00 


5.00 


46 BUN UREA NITRATE 




5.00 


6.00 


6.00 


5.00 


5.00 


6.00 


6.00 


4.00 


47 PAP TEST 




15.00 


10.00 


15.00 


15.00 


10.00 


8.00 


8.25 


10. 00 


48 URINALYSIS 




4.00 


4.00 


3.00 


3.00 


4.00 


4.00 


3.00 


3. 00 


49 ELECTROCARDIOGRAM 




25.00 


25.00 


20.00 


22.50 


22.00 


25.00 


20.00 


20.00 


50 ELECTROENCEPHALOGRAM 




55.00 


55.00 


55.00 


55.00 


50.00 


55.00 


50.00 


50.00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
| : 14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



119 



PUERTO RICO 



San Juan, Hato Rey, Santurce, & 
Rio Piedra3 
01 




PUERTO RICO 






Four Localities: 

01 Cities of San Juan, Hato Rev, Santurce, Rio Piedras 
(San Juan Metropolitan area) 

02 Cities of Ponce, Mayaguez, San German, Bayamon, Caguas, Guayama 

03 Cities of Arecibo, Humacao, Aguadilla, Fajardo, Carolina 
and Guaynabo 

04 The rest of the towns in Puerto Rico 



VIRGIN ISLANDS 



(Locality is determined by the city cited in the 
return address.) 



One Locality - Too small for separate screens. Handled by the 

Puerto Rico carrier. 120 



1977 PREVAILING CHARGE SUMMARY DATA 



SEGUROS DE SERVICIO DE SALUD PR. 



PUERTO RICO 



LOCALITY DESIGNATION FOR 



PROCEDURE DESCRIPTION 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

1 7 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



INITIAL 
INITIAL 
MINIMAL 
ROUTINE 
ROUTINE 
INITIAL 
INITIAL 
ROUTINE 
BIOPSY 



LIMITED OFFICE VISIT 

COMP OFFICE VISIT 

OFFICE VISIT 

BRIEF OFFICE VISIT 
HOME VISIT 
HOSPITAL VISIT 
HOSPITAL VISIT 
HOSPITAL VISIT 



BRIEF 
BRIEF 
COMP 
BRIEF 
SKIN 



RADICAL MASTECTOMY 

REDUCTION OF FRACTURE 

ARTHOTMY 

NEEDLE PUNCTURE OF BURSA 

BRONCHOSCOPY 

THORACENTESIS 

CATHETERIZATION 

INSERTION OF PACEMAKER 

BLOOD TRANFUSION 

COLECTOMY 

APPENDECTOMY 

SIGMOIDOSCOPY 

HEMORRHOIDECTOMY 

CHOLECYSTECTOMY 

REPAIR HERNIA 

CYSTOSCOPY 

DILATION OF URETHRA 

PROSTATECTOMY 

ELECTROSECTION OF PROSTATE 

HYSTERECTOMY 

EXTRACTION OF LENS 

X-RAY CHEST 

X-RAY SPINE 

X-RAY HIP 

X-RAY STOMACH 

X-RAY COLON 

COBALT 

RADIOTHERAPV 

HEMOGLOBIN 

WHITE CELL COUNT 

COMPLETE BLOOD COUNT 

CHOLESTERAL BLOOD COUNT 

HEMATOCRIT 

PROTHROMBIN 

SEDIMENTATION RATE 

BLOOD SUGAR 

BUN UREA NITRATE 

PAP TEST 

URINALYSIS 

ELECTROCARDIOGRAM 

ELECTROENCEPHALOGRAM 



AREA 1 

10.00 
10.00 

10.00 
15.00 
20.00 
15.00 
10.00 



AREA 2 AREA 3 



15.00 

420.00 
250.00 



3.00 



10.00 
10.00 

10.00 
15.00 
15.00 
15.00 
10.00 
25.00 



10.00 
10.00 

10.00 
12.80 
15.00 
20.00 
10.00 
35.00 



15.00 



300.00 



175.00 
20.00 
150.00 
360.00 
2 1 . 00 
35.00 



3.00 



5.00 



GENERAL PRACTICE 

AREA 4 

10.00 
10.00 



10.00 
12.80 
15.00 
15.00 
10.00 
15.00 



LOCALITY DESIGNATION FOR SPECIALIST 
AREA 1 AREA 2 AREA 3 AREA 4 



1 58 . 00 



255 . 20 



11 .50 


tl 


50 


11 .50 


11 


50 


46.00 


46 


00 


45.00 


46 


00 


23.00 


23 


00 


23. 00 


23 


00 


57.50 


57 


50 


57.50 


57 


50 


46.00 


46 


00 


46.00 


46 


00 



3.00 



0.00 


7.00 


10.00 


5.00 


9.00 


5.00 


10.00 


5.00 


3.00 




5.00 


4.00 


5.00 






5.00 


5.00 


6.00 ; 


: 4 . 00 


5.00 


7.00 


5.00 


10.00 


5.00 


5.00 


5.00 


4.00 


5.00 


5.00 


25.00 


25.00 


25.00 





1 5 . 00 


12.80 


1 2 . 80 


10.00 




30.00 


25.00 


- 25.00 


20.00 




15.00 


13.90 


14.20 


10.00 


'^:-yk- ;><•'<:■ '■:•:■■ 


25.00 


19. 10 


1 5 . 00 


15.00 




30.00 


25.00 


25.00 


25.00 




30.00 


25.00 


25.00 


20.00 




12.80 


12.80 


12.80 


10.00 




38.30 


31 .90 


40.00 






750.00 


765.60 








800.00 


765.60 







117.40 100.00 



800.00 


638.00 






350.00 


300.00 


250.00 


250.00 


30.00 


15.00 


25.00 


25.00 


300.00 


300.00 






6 1 2 . 50 


510.40 


500.00 


450.00 


382.80 


312.60 


255.20 


319.00 


50.00 


44.70 


40.00 




800.00 


640.00 


638.00 




800.00 


640.00 


510.40 




638.00 


550.00 


510.40 




600.00 


500.00 


600.00 


: 


1 1 .50 


1 T . 50 


11.50 


11.50 


46.00 


46.00 


46.00 


46.00 


23.00 


23.00 


23.00 


23 . 00 


57.50 


57.50 


57.50 


57.50 


46.00 


46.00 


46.00 


46.00 


25.00 


17.00 






40.00 


23.00 






2.00 


3.00 


2.00 


3.00 


8.00 


5.00 


6.00 


5.00 


8.00 


5.00 


5.00 


5.00 


3.00 


3.00 


3.00 




6.00 


10.00 






6.00 


5.00 






5.00 








6.00 


5.00 


7.00 




5.00 


3.00 


5.00 


3.00 


25.00 


25.00 


25.00 


25.00 


40.00 


40.00 


40.00 





01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

1 1 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



121 



RHODE iSLAND 




WEST GREEN WIC I 
( WASHINGTON CO. 

E X t T E » 




/ r? 4 ) j) 7 Mr™ 3 

\ JAMESTOWN 1 /C\ \ !j 

1) 



; MIDDLETOWN 




One Locality - Statewide 



122 



1977 PREVAILING CHARGE SUMMARY DATA B/S OF RHODE ISLAND 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 
■'i 14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 C03ALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 
SINGLE 

15.00 

30.00 

10.21 

10-21 

15.00 

25.00 

31 .91 

15.00 

25.53 
650.00 
600.00 

19. 15 

15-00 
159.55 

31 .91 
250.00 
380.37 

25.00* 
750.00 
319.10 

31 -91 

250.00 

525.00 

300.00 

63.82 

12.00 
681 .60 
574.38 
600.00 

1 5 . 00 
25.53 
19.15 
44.67 
38.29 
43.30* 



5.00 
2.00 
8.00 
7-00 
5.00 
6.00 
5.00 
6.00 
5.00 
6.00 
4.00 
25.00 
40.00 



';■.-' ."■ ■ ■ 



RHODE ISLAND 
LOCALITY DESIGNATION FOR SPECIALIST 

SINGLE 

25.00 
44.67 
12.76 
12.76 
19.15 ' : 
45.00 
50.00 
14.15 
25.00 
650.00 
600.00 
29.48 
20.00 
200.00 
38.29 
1 75.00 
380.37 
25.00* 
750.00 
324.23 
35.00 
250.00 
525.00 
300.00 
60.00 
12.00 
681 . 60 
610.72 
600.00 
525.00 
15.00 
22.50 
20.00 
: 44.67 
38.29 
43.30 



2.50 
2.00 
7.00 
5.00 
3.00 
6.00 
5.00 
6.00 
5.00 
7.00 
4.00 
20.00 
40.00 



.■-■. 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

Ifi 

17 

16 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



123 



SOUTH CAROLINA 




Three Localities: 

01 Metropolitan Areas: Anderson, Greenville, Spartanburg, 

Richland, Orangeburg, Charleston Counties 

02 Urban Areas: Pickens, Laurens, Greenwood, York, Lexington, 

Aiken, Sumter, Darlington, Florence, 3crkeley, 
Horry, Bcufort Point Counties 

03 Rural Areas: Oconee, Cherokee, Union, Chester, lancaster, 

Chesterfield, Marlboro, Kershaw, Fairfield, 
Newberry, Abbeville, McConcick, Edgefield, 
Saluda, Calhoun, Lee, Dillon, Marion, George- 
town, Williansburg, Clarendon, Dorchester, 
Bamberg, Barnwell, Colleton, Hampton, Allendale, 
Jasper Counties 12U 



1977 PREVAILING CHARGE SUMMARY DATA B/C-B/S OF SOUTH CAROLINA 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



SOUTH CAROLINA 



PROCEDURE DESCRIPTION 



METRO 



URBAN 



01 


INITIAL LIMITED OFFICE 


VISIT 


7.66 


7.66 


02 


INITIAL COMP OFFICE 


VISIT 


25.00 


25-00 


03 


MINIMAL OFFICE VISIT 




7.66 


7-66 


04 


ROUTINE BRIEF OFFICE VISIT 


7.66 


7.66 


05 


ROUTINE BRIEF HOME VISIT 


12.76 


12.76 


06 


INITIAL BRIEF HOSPITAL 


VISIT 


10.00 


8.93 


07 


INITIAL COMP HOSPITAL 


VISIT 


31 .90 


30.00 


08 


ROUTINE BRIEF HOSPITAL 


VISIT 


10.00 


8.93 


09 


BIOPSY SKIN 




25.00 


25.00 


10 


RADICAL MASTECTOMY 




540.00 


540.00 


11 


REDUCTION OF FRACTURE 




535.92 


535. S2 


12 


ARTHOTMY 




16.32 


20.00 


13 


NEEDLE PUNCTURE OF BURSA 


15.00 


15.00 


14 


BRONCHOSCOPY 




127.60 


127.60 


15 


THORACENTESIS 




25.00 


25.00 


16 


CATHETERIZATION 




400.00 


400.00 


17 


INSERTION OF PACEMAKER 




300.00 


300.00 


18 


BLOOD T RAN FUSION 




15.00 


15.00 


19 


COLECTOMY 




640.00 


640.00 


20 


APPENDECTOMY 




250.00 


180.00 


21 


SIGMOIDOSCOPY 




31 .90 


20.00 


22 


HEMORRHOIDECTOMY 




267.96 


267.96 


23 


CHOLECYSTECTOMY 




350.00 


350.00 


24 


REPAIR HERNIA 




250.00 


250-00 


25 


CYSTOSCOPY 




50.00 


50.00 


26 


DILATION OF URETHRA 




14.89 


14.89 


27 


PROSTATECTOMY 




612.48 


612.48 


28 


ELECTROSECTION OF PROSTATE 


580.00 


580.00 


29 


HYSTERECTOMY 




515.00 


515.00 


30 


EXTRACTION OF LENS 




510.40 


510.40 


31 


X-RAY CHEST 




15.00 


1 5 . 00 


32 


X-RAY SPINE 




30.00 


25.00 


33 


X-RAY HIP 




15.11 


21 .03 


34 


X-RAY STOMACH 




38.92 


42.57 


35 


X-RAY COLON 




35.00 


35.00 


36 


COBALT 




12.00 


12.00 


37 


RADIOTHERAPY 




12.00 


12.00 


38 


HEMOGLOBIN 




3.00 


3.00 


39 


WHITE CELL COUNT 




3.00 


3.00 


40 


COMPLETE BLOOD COUNT 




7 . 00 


5 . 00 


41 


CHOLESTERAL BLOOD COUNT 




6.00 


5.00 


42 


HEMATOCRIT 




3.00 


4.00 


43 


PROTHROMBIN 




5.00 


6.00 


44 


SEDIMENTATION RATE 




3.50 


5-00 


45 


BLOOD SUGAR 




5.00 


5.00 


46 


BUN UREA NITRATE 




5.00 


5.00 


47 


PAP TEST 




7.50 


10.00 


48 


URINALYSIS 




3.00 


3.00 


49 


ELECTROCARDIOGRAM 




15.00 


16.00 


50 


ELECTROENCEPHALOGRAM 




45.29 


45.29 



ACTICE 


LOCALITY 


DESIGNATION FOR 


SPECIALIST 




RURAL 


METRO 


URBAN 


RURAL 




6.38 


11 . 48 


8.93 


7.66 


01 


25.00 


44.66 


35.00 


31 .90 


02 


6.38 


8.00 


5.00 


7.66 


03 


6.38 


11 .48 


8.93 


7.66 


04 


12.76 


19. 14 


15.00 


12.76 


05 


10.00 


12.00 


10.00 


8.93 


06 


31 .90 


44.66 


40.00 


40.00 


07 


10.00 


12.00 


10.00 


8.93 


08 


25.00 


38. 10 


25.00 


31 .93 


09 


540.00 


550.00 


510.40 


532.10 


10 


535.92 


535.92 


712.44 


670.45 


11 


15.00 


19.59 


23.26 


19. 15 


12 


25.00 


23.95 


2 1 . 00 


2 1 . 00 


13 


i 27-60 


127.60 


127.60 


127.60 


14 


25.00 


40.00 


40.00 


40.00 


15 


400.00 


326.62 


350.00 


350.00 


16 


300.00 


125.00 


125.00 


125.00 


17 


15.00 


10.00 


10.00 


10.00 


18 


640.00 


650.00 


638.00 


638.52 


19 


250.00 


285.00 


255.20 


250.00 


20 


19. 14 


31 .90 


25.00 


31 .90 


21 


267.96 


300.00 


223.30 


226.23 


22 


350.00 


450.00 


400.00 


446.60 


23 


252.00 


275.00 


255.20 


250.00 


24 


50.00 


50.00 


40.00 


50.00 


25 


15.00 


15.00 


12.76 


12.76 


26 


612.48 


640.00 


560.00 


595.96 


27 


580.00 


600.00 


510.40 


580.00 


28 


515.00 


5 1 5 . 00 


510.40 


5 1 5 . 00 


29 


510.40 


510.40 


510.40 


532:10 


30 


15.00 


6.00 


5.26 


5.26 


31 


20.31 


9.00 


1 . 00 


1 . 00 


32 


21 .03 


10.00 


10.00 


10.00 


33 


38.92 


19.14 


20.00 


20.00 


34 


35.00 


18.00 


20.00 


20.00 


35 


12.00 


12.00 


12.00 


12.00 


36 


12.00 


12.00 


12.00 


12.00 


37 


3.00 


3.00 


3.00 


3.00 


38 


3.00 


3.00 


3.00 


3.00 


39 


6.00 


7.00 


5.00 


6.00 


40 


8.00 


5.50 


6.00 


6.00 


41 


3.50 


3.0Q 


3.00 


2.00 


42 


6.00 


5.00 


5.00 


4.00 


43 


4-00 


5.00 


5.00 


3. 00 


44 


6.00 


' 6 . 00 


6.00 


7.00 


45 


5.00 


6.00 


6.00 


7.00 


46 


6.00 


6.00 


7.00 


10.00 


47 


3.00 


4.00 


3.00 


4.00 


48 


15.00 


17.47 


15.00 


15.00 


49 


45.29 


50.00 


50.00 


50.00 


50 



125 



SOUTH DAKOTA 



k 



~P- 




One Locality - Statewide 



126 



1977 PREVAILING CHARGE SUMMARY DATA 



SOUTH DAKOTA MEDICAL SERVICE 



SOUTH DAKOTA 



COMBINED LOCALITY DESIGNATION 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA • 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT > 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



: : ; :': : : : :-: : .v.- 



' 






SINGLE 

1 5 . 00 

■ 33.00 

5.10 

7 . 70 

12.80 

25.00 

44.70 

7.70 

23.00 

536.10 

510.60 

12.80 

13.00 

127.60 

23.00 

765-80 

12.80 

638.20 

282.00 

23.00 

2 1 • 00 

459.50 

268.00 

38.30 

15.00' 

612.70 

574.40 

4 90.00 

6 1 2 . 70 

15.00 

24.00 

25.50 

46.00 

40.00 

12.80 

20.00 

3.00 

3.25 

7.70 

7.00 

3.25 

6.40 

3.80 

6.40 

7.50 

8.50 

3.80 

19.20 

60.00 






01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



127 



TENNESSEE 



NASHVILLE DAVIDSON 




One Locality - Statewide 



128 



1977 PREVAILING CHARGE SUMMARY DATA EQUITABLE LIFE ASSURANCE SOCIETY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 
X-RAY CHEST 
X-RAY SPINE 
X-RAY HIP 
X-RAY STOMACH 
X-RAY COLON 



31 
32 
33 
34 
35 
3G COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



35 

12.80 

31 .90 

3.80 

6.40 

12.00 

19.20 

35.00 

7.70 

20.00 

600.00 

500.00 

12.80 

12-80 

100.00 

25.00 

2 1 . 00 

600.00 

15.00 

500.00 

280.00 

19. 20 

250.00 

431 .00 

250.00 

25.00 

12.80 

567.00 

561 .60 

400.00 

500.00 

14.00 

22.30 

25.00 

40 . 00 

35.00 

15.00 

17.00 

3.00 

3.00 

8.00 

6.00 

3.00 

5.00 

5.00 

5.00 

5.00 

9.00 

3.00 

15.00 

50.00 



TENNESSEE 
LOCALITY DESIGNATION FOR SPECIALIST 

35 

1 5 . 00 

38.30 
4.00 
8.90 

15.00 

19.20 

44.70 

10.00 

30.00 

650.00 

:. 638.20 

15.00 

15.00 
120.00 

35.00 
255.30 
638.20 
8.90 
638.20 
315.00 

23.00 
255.30 
462.70 
287.20 

31 .90 

10.00 
567.00 
561 .00 
510.60 
500.00 

1 5 . 00 

25.00 

19.00 

42.00 

38.30 

15.00 

17.00 
3. 
3. 



.00 
.00 
8.00 
8.00 



00 
00 



4.00 
7.00 
8.00 
8.00 
3.80 
17.00 
40.00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



129 



TEXAS 



HEHTPHILL 



TEZAS - Statewide -Z(eO 




Thirty-two Localities 

(For more locality information 
see Appendix A) 

Note: 226, 23£ locality data not available 



130 



1977 PREVAILING CHARGE SUMMARY DATA GROUP MEDICAL AND SURGICAL SERV. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE ERIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



014 

8.00 
25.00 

7-00 

15.30 

31 -90 

31 .90 

10.00 

19.10 

437.70 

500.20 

15.00 

12.80 

94.40 

19.10 

37510 

262.50 

12.50 

625.20 

250.10 

26.25 

250.10 

275.10 

219.50 

31 .90 

12.80 

415.00 

500.20 

437.70 

600.00 

15.00 

25.50 

19.10 

40.00 

37.00 



6.50 

3.00 

9.00 

7.00 

3.00 

7.00 

5.00 

6.00 

7.00 

13.00 

4.50 

18.00 

44.70 



015 

10.00 
25.00 

10.00 

15.30 

35.00 

40.00 

15.00 

15.00 

630 . 00 

760.00 

17.50 

15.00 

144.20 

30.00 

550.00 

350.00 

12.50 

720.00 

350.00 

30.00 

350.00 

550.00 

315.00 

25.50 

15.00 

4 1 5 . 00 

640.00 

540.00 

600.00 

15.00 

31 .90 

20.00 

44.70 

39.00 



6.50 

3.00 

8.00 

7.00 

3.00 

6.00 

7.00 

7.00 

7.00 

10.00 

4.75 

24.20 

52.50 



019 

8.90 
25.00 

8-90 

12.80 

20.00 

31 .90 

10.00 

20.00 

589.50 

673.70 

15.00 

15.00 

126.30 

30.00 

475.00 

262.50 

12.50 

750.00 

255.20 

25.50 

336.90 

3 1 9 . CO 

275.00 

40.00 

12.80 

415.00 

640.00 

540.00 

600.00 

12.80 

25.00 

19-10 

45.00 

39.00 



6.50 
4.00 
6.00 
6.00 
3-00 
6.00 
6.00 
6.00 
7.00 
6.00 
5.00 
15.00 
52.50 



020 

8 . 00 
15.00 

8 . 90 

15.00 

25.50 

25.00 

12 .80 

20.00 

574.20 

804 . 30 

15.00 

15.00 

125.00 

25.50 

475.00 

262 .50 

12.50 

638.00 

300 . 00 

25.50 

331 .80 

446.60 

275.00 

40.00 

15.00 

415.00 

64O.OO 

540 . 00 

600 . 00 

16.00 

25.00 

19. 10 

38.30 

39.00 



6.50 

4.00 

7.00 

7.50 

3.00 

7.00 

6.00 

7.00 

5.00 

10.00 

5.00 

19. 10 

52.50 



031 

10. 00 
25.00 

6.40 

10-00 

30-00 

31 .90 

9.00 

10.00 

571 .00 

653.30 

15.00 

15.00 

125.00 

30.00 

475.00 

262.50 

12.50 

750.00 

300.00 

30.00 

326.70 

490. 00 

275.00 

40-00 

15.00 

4 1 5 . 00 

640.00 

540.00 

600 . 00 

15.00 

25.00 

20 . 00 

45.00 

39.00 



6.5O 

4.00 

8. 40 

6-00 

3-00 

6.00 

6.00 

6.00 

6.00 

15.00 

3.60 

20.00 

48.50 



TEXAS 
LOCALITY DESIGNATION FOR SPECIALIST 

014 015 019 020 031 



16-00 










10.00 


01 


40.00 










44.70 


02 
03 


12.00 










8.90 


04 


18.00 










19. 10 


05 


38.30 










30.00 


06 


50.00 










42.00 


07 


12.80 










9.60 


08 


30.00 


26 


80 


12 


00 


26.00 


09 


630-00 


473 


40 


527 


00 


556.00 


10 


535.00 












11 


20.00 












12 


15.00 


14 


00 


15 


00 


15.00 


13 


175.00 


102 


10 


113 


60 


1 1 3 . 60 


14 


50.00 


20 


40 


23 


00 


50.00 


15 


500.00 












16 


250.00 












17 


10.00 


10 


00 


10 


00 


10.00 


18 


720.00 


500 


00 


750 


00 


574.20* 


19 


360.00 


255 


20 


405 


60 


300.00 


20 


31 .90 


23 


50 


23 


00 


30.00 


21 


320.00 


270 


50 


301 


10 


1 9 1 . 40 


22 


540.00 


382 


80 


451 


70 


446.60 


23 


350.00 


255 


20 


275 


00 


255.20 


24 


31 .90 












25 


10.00 












26 


638-00 












27 


612-50 












28 


759.70 












29 


600.00 












30 


19.00 












31 


29.00 












32 


21 .00 












33 


39 . 00 












34 


38.00 












35 
36 

37 


3.00 










3.00 


38 


3.00 










3.00 


39 


8.00 










7.00 


40 


7.50 










8.00 


41 


3.00 










3.00 


42 


6.00 










6.50 


43 


5.00 










5.00 


44 


7.00 










7.00 


45 


7.00 










8.00 


46 


10.00 










10.00 


47 


5.00 










5.00 


48 


20.00 










20.00 


49 
50 



131 



1977 PREVAILING CHARGE SUMMARY DATA GROUP MEDICAL AND SURGICAL SERV. 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 



057 



061 



068 



071 



084 



TEXAS 
LOCALITY DESIGNATION FOR SPECIALIST 

057 061 068 071 084 



01 INITIAL LIMITED OFFICE 


VISIT 


15.00 


10.00 


10.00 


9.00 


10-00 


25.00 










15.00 


15.00 


01 


02 INITIAL COMP OFFICE 


VISIT 


30-00 


44.70 


25.00 


25.00 


25.00 


44.70 






• 




38.00 


50.00 


02 


03 MINIMAL OFFICE VISIT 




























03 


04 ROUTINE BRIEF OFFICE VISIT 


10.00 


9.60 


6.40 


7.70 


8. 90 


12.80 










10-00 


15.00 


04 


05 ROUTINE BRIEF HOME VISIT 


19.10 


13.70 


12.80 


20.00 


15.00 


23.00 










19. 10 


20.00 


05 


06 INITIAL BRIEF HOSPITAL 


VISIT 


31 .90 


23.00 


25.00 


25.00 


29.30 


45.00 










35.00 


40.00 


06 


07 INITIAL CCMP HOSPITAL 


VISIT 


35.00 


40.00 


30.00 


25.00 


35.00 


45.00 










40.00 


63.80 


07 


08 ROUTINE BRIEF HOSPITAL 


VISIT 


15.00 


10.00 


8.00 


11 .00 


12.00 


12.50 










12.80 


15.30 


08 


09 BIOPSY SKIN 




25.00 


20.00 


20.00 


20.00 


20.00 


29.00 


23 


00 


23 


00 


25.50 


25.50 


09 


10 RADICAL MASTECTOMY 




678.80 


634.20 


527.00 


571 .60 


571 .60 


825.00 


535 


90 


632 


80 


712.50 


750.00 


10 


11 REDUCTION OF FRACTURE 




760.00 


724.80 


602.30 


653.30 


653.30 


638.00 










720.00 




11 


12 ARTHOTMY 




1 5 . 00 


15.00 


15.00 


19. 10 


18.00 


15.00 










20.00 




12 


13 NEEDLE PUNCTURE OF BURSA 


15.00 


1 5 . 00 


1 5 . 00 


15.00 


15.00 


15.00 


15 


00 


15 


00 


14.25 


15.00 


13 


14 BRONCHOSCOPY 




125.00 


136.50 


113.60 


122.50 


122.50 


159.50 


127 


60 


111 


00 


166.25 


125.00 


14 


15 THORACENTESIS 




30.00 


28. 10 


23. CO 


25.50 


25.50 


50.00 


50 


00 


23 


00 


47.50 


31 .90 


15 


16 CATHETERIZATION 




375.00 


475.00 


451 .70 


475.00 


475.00 


375.00 














16 


17 INSERTION OF PACEMAKER 




200.00 


262.50 


262.50 


262.50 


262.50 


200 00 














1 ; 


18 BLOOD TRANFUSION 




12.50 


12.50 


12.50 


12.50 


12.50 


10.00 


10 


00 


10 


00 


9.50 


10.00 


18 


19 COLECTOMY 




825.00 


750.00 


750.00 


750.00 


750.00 


850.00 


574 


20 


638 


00 


712.50 


750.00 


19 


20 APPENDECTOMY 




300.00 


300.00 


300.00 


255.20 


300-00 


350.00 


319 


00 


255 


20 


332.50 


350.00 


20 


21 SIGMOIDOSCOPY 




30.00 


31 .70 


23.00 


25.50 


35.00 


30.00 


25 


00 


24 


30 


42.75 


44.70 


21 


22 HEMORRHOIDECTOMY 




350.00 


350.00 


301 . tO 


326.70 


326.70 


350.00 


306 


20 


296 


00 


272.75 


320.00 


22 


23 CHOLECYSTECTOMY 




510.40 


500. CO 


451 .70 


500.00 


500.00 


600.00 


446 


60 


510 


40 


475.00 


540.30 


23 


24 REPAIR HERNIA 




275.00 


255.20 


264.10 


275 . 00 


275.00 


350.00 


319. 


00 


275 


00 


303.10 


350.00 


24 


25 CYSTOSCOPY 




35.00 


40.00 


38.30 


40.00 


40.00 


35.00 














25 


26 DILATION OF URETHRA 




15.00 


15.00 


15.00 


15.00 


12-80 


10.00 














26 


27 PROSTATECTOMY 




4 1 5 . 00 


415.00 


415.00 


4 1 5 . 00 


4 1 5 . 00 


650.00 














27 


28 ELECTROSECTION OF PROSTATE 


670.00 


640.00 


602.30 


640.00 


640.00 


638.00 














28 


29 HYSTERECTOMY 




540.00 


540.00 


527.00 


540 . 00 


540.00 


662.70 










611.30 


750.00 


29 


30 EXTRACTION OF LENS 




650.00 


600.00 


600.00 


500 . 00 


600.00 


593.30 










500.00 




30 


31 X-RAY CHEST 




17.50 


1 8 . 00 


14.00 


12.50 


19.10 


18.00 














31 


32 X-RAY SPINE 




25.00 


25.00 


19. 10 


25.50 


35.00 


25.00 














32 


33 X-RAY HIP 




17.50 


20 . 00 


45.00 


19.10 


22.50 


18.50 














33 


34 X-RAY STOMACH 




44.70 


38.30 


39.00 


44.70 


45.00 


45 . 00 














34 


35 X-RAY COLON 




40 . 00 


39.00 




39.00 


38.30 


.45.00 














35 


36 COBALT 




























36 


37 RADIOTHERAPY 




























37 


38 HEMOGLOBIN 




6.50 


6.50 


6.50 


6.50 


6.50 


5.00 










3.00 


3.00 


38 


39 WHITE CELL COUNT 




5.00 


4.00 


4.00 


4.00 


5.00 


3.00 










3.00 


3.00 


39 


40 COMPLETE BLOOD COUNT 




8.00 


8.00 


7.50 


7.00 


8.00 


8.00 










6.00 


: 7.50 


40 


41 CHOLESTERAL BLOOD COUNT 




7.00 


7.00 


8. CO 


7.50 


8.50 ■ 


7.00 










6.00 


6 . 00 


41 


42 HEMATOCRIT 




2.50 


4.00 


3.00 


2.00 


3.00 


3.00 










2.00 


3.00 


42 


43 PROTHROMBIN 




7.50 


7.00 


6.00 


10.00 


7.00 


7.00 










7.00 


8.00 


43 


44 SEDIMENTATION RATE 




6.00 


6.00 


6.00 


5.00 


6.00 


5.00 










5.00 


i: 6.00 


. ' 44 


45 BLOOD SUGAR 




7.50 


7.00 


7.50 


7 . 00 


7.00 


7.00 










6.00 


7.00 


45 


46 BUN UREA NITRATE 




6.00 


7.00 


7.00 


8.00 


7.00 


6.00 










6.00 


7.00 


46 


47 PAP TEST 




15.00 


15.00 


15.00 


10.00 


12.00 


10.00 










13.75 


10.00 


47 


48 URINALYSIS 




5.00 


5.00 


5.00 


6.00 


5.00 


5.00 










4.00 


5.00 


48 


49 ELECTROCARDIOGRAM 




20.00 


20.00 


17.50 


19. 10 


19.10 


20.00 










19.10 


22.30 


49 


50 ELECTROENCEPHALOGRAM 




38.30 


51 .00 


48.50 


52.50 


52.30 
















50 



132 









1977 PREVAILING CHARGE SUMMARY DATA GROUP MEDICAL AND SURGICAL SERV. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 
PROCEDURE DESCRIPTION 091 092 101 108 123 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



TEXAS 
LOCALITY DESIGNATION FOR SPECIALIST 

091 092 101 108 123 



7.00 


25.50 


12.20 


10.00 


14.10 










19.10 


12.00 


20.00 


01 


25.00 


25 . 00 


30.00 


15.00 


25.00 










44.70 


31.90 


50.00 


02 
03 
04 


6.40 


7.70 


8.90 


6.40 


8.90 










12.80 


10-00 


1 2 . 80 


12.00 


12.80 


18.00 


12.00 


15.30 






■ 


. 


19. 10 


19. 10 


12.80 


05 


19. 10 


25.00 


31 .90 


25.00 


31 .90 










38.30 


31 .90 


35.00 


06 


25.00 


25.00 


35.00 


31 .90 


35.00 










50. OC 


31 .90 


50.00 


07 


10.20 


8.00 


13.00 


10.00 


12.00 










12.80 


8.00 


12.80 


08 


20.00 


20.00 


15.00 


20.00 


20.00 


20 


00 


45 


30 


25.00 


20.00 


34.50 


09 


473.40 


482.30 


616.30 


250.00 


607.40 


574 


.00 


510 


40 


765.60 


518. 10 


638.00 


10 


541 .00 


551 .00 


900.00 


592. 10 


694. 10 










701 .80 




510.40 


11 


10.00 


12.80 


12.50 


19. 10 


20.00 










15.00 




15.00 


12 


14.00 


14.00 


15.00 


15.00 


12.80 


14 


00 


14 


00 


15.00 


15.00 


15.00 


13 


102. 10 


103.40 


132.70 


127.60 


150-00 


127 


60 


127 


60 


159.50 


127.60 


100.00 


14 


21 .50 


21 .70 


50.00 


23.00 


30.00 


35 


00 


31 


90 


50.00 


23.00 


50.00 


15 


405.80 


413.40 


460.00 


444 . 00 


4 75.00 










460.00 






16 


262.50 


262.50 


300.00 


262 .50 


262.50 










191 .40 






17 


12.50 


12.50 


12.50 


12.50 


12.50 


10 


00 


10 


00 


10.00 


12.50 


10.00 


18 


290.90 


689-00 


880.40 


740. 10 


750.00 


750 


00 


574 


20 


893.20 


740. 10 


638.00 


19 


255.20 


285.00 


382.80 


250.00 


300.00 


255 


20 


287 


10 


382.80 


250.00 


300.00 


20 


21 .50 


20.00 


35.00 


23.00 


35.00 


24 


00 


20 


40 


35.00 


23.00 


39.50 


21 


270.50 


275.60 


350.00 


296.00 


347. tO 


2 70 


50 


270 


50 


350.00 


296.00 


3 1 9 . 00 


22 


4 1 4 . 70 


413.40 


550.00 


500 . 00 


500.00 


400 


00 


446 


60 


638.00 


500.00 


540.00 


23 


255.20 


275.00 


300.00 


255.20 


275.00 


250 


00 


275. 


00 


382.80 


255.20 


300.00 


24 


34.50 


34.50 


50.00 


37.00 


40 . OO 










50.00 






25 


15.00 


12.80 


15.00 


15.00 


12.80 










15.00 






26 


415.00 


415.00 


415.00 


415.00 


4 1 5 . 00 










638.00 






27 


541 .00 


551 .20 


704.00 


592. 10 


640.00 










829.00 






28 


473.40 


482.30 


540.00 


518. 10 


540.00 










638.00 




600.00 


29 


600.00 


600.00 


638.00 


600 . 00 


600.00 










630.00* 






30 


15.00 


17.50 


15.00 


17.00 


19.10 










35.00 






31 


25.00 


25.00 


30.00 


25.00 


38 . 30 










20.00 






32 


16.00 


19.10 


19.10 


22.00 


23.00 










44.70 






33 


45.00 


45.00 


45.00 


45.00 












40.00 






34 


39.00 


39.00 


36.00 


39.00 


















35 

35 


6.50 


6.50 


6.50 


6.50 












3.00 


3.00 


3.00 


37 
38 


3.00 


4.00 


6-00 


2.50 












4.00 


3.00 


3.00 


39 


7.00 


7.00 


7 . 50 


6.00 












7.50 


6.50 


7.50 


40 


5.00 


7.00 


6. CO 


7.00 












8.00 


6.50 


6.00 


41 


3.00 


3.00 


6.00 


4.00 












3.00 


3.00 


5.00 


42 


6.00 


7.50 


7.00 


6.00 












7.00 


6.00 


6.50 


43 


6.00 


4.00 


6-00 


5.00 












5.00 


6.00 


5.00 


44 


6.00 


6 . 00 


7.00 


6 . 00 












8.00 


6.00 


6.00 


45 


7.00 


7.00 


6.00 


6.00 












8.00 


6.50 


6.00 


46 


10.00 


10.00 


15.00 


16.00 












10.00 


15.00 


14.50 


47 


4.00 


5.00 


5.00 


4.00 












5.00 


5.50 


5.00 


48 


15.00 


19.10 


19. 10 


19.10 












20.00 


22.00 


20. 00 


49 


44.70 


51 .00 


52.50 


51 .00 


















50 






133 



1977 PREVAILING CHARGE SUMMARY DATA GROUP MEDICAL AND SURGICAL SERV. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 
18 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



152 



155 



165 



178 



181 



TEXAS 
LOCALITY DESIGNATION FOR SPECIALIST 

152 155 165 178 181 



10.00 


10.00 


12-80 


12.00 


10.00 


2 1 - 00 


19. 10 


31.90 


25.00 


25.00 


25.00 


25.00 


40.00 


27.50 


8.00 


6.40 


8.00 


7.70 


8.00 


12.50 


7.70 


10.00 


8.90 


18.20 


19.10 


15.00 


15.00 


15.00 


25.00 


20.00 


31 -90 


25.50 


31 .90 


40.00 


21 .00 


27.50 


31 .90 


30.00 


44.70 


35.00 


40.00 


50.00 


8.00 


8.00 


7.70 


12.80 


10.00 


9.00 


9.00 


15.00 


20.00 


20.00 


20.00 


20.00 


20.00 


25.50 


459.40 


535.90 


535.90 


580.60 


562.70 


600-00 


606. 10 


382.80 


6 1 2 . 50 


6 1 2 . 50 


663.50 


643. 10 






12.00 


15.00 


15.00 


19.10 


15.00 






15.00 


12.80 


15.00 


15.00 


15.00 


15.00 


15.00 


1 1 1 . 00 


114.80 


1 1 4 . 80 


125.00 


121 .20 


1 1 3 . 60 


159.50 


30.00 


23.00 


23.00 


25.50 


25.00 


27.90 


31 .90 


444.00 


459 .<3C 


459.40 


475.00 


475. 00 






262.50 


262.50 


262.50 


262 .50 


262.50 






12.50 


12.50 


12.50 


12.50 


12.50 


10.00 


10.00 


510.40 


750.00 


750.00 


705.00 


750.00 


510.40 


520.00 


268.00 


300.00 


300-00 


300.00 


300 . OO 


310.00 


250.00 


23.00 


23.00 


20-00 


28.80 


40-00 


25.00 


25.00 


296.00 


306.20 


305.20 


331 -80 


321 .60 


301.10 


331 .80 


446.60 


459.40 


459.40 


500 . 00 


382.80 


4 1 4 . 70 


400.00 


268.00 


268.00 


255.20 


275.00 


275.00 


287.10 


255.20 


40.00 


38.30 


570.00* 


40.00 


40.00 






15-00 


15.00 


15.00 


15.00 


15.00 






415.00 


4 1 5 . 00 


415.00 


415.00 


4 1 5 . 00 






592. 10 


612.50 


612.50 


640.00 


640.00 






518.10 


535.90 


535.90 


540.00 


540.00 


571.60 




600.00 


600.00 


600 . 00 


600 . 00 


600.00 


5 1 . 40 


:*:+:•:'■:■:■;■>:•: ' ' 


15-00 


12.80 


15.00 


20.00 


21-70 






25.00 


20.00 


25.00 


27 . 75 


25.00 






18.00 


19. 10 


12.80 


20.00 


20. 00 






44.70 


45.00 


45.00 


44.70 


44.70 






39.00 


39.00 


39.00 


39.00 


39-00 






6.50 


6.50 


6.50 


6.50 


6.50 


3.00 


3.00 


4.00 


4.00 


4.00 


3.00 


4.00 


3.00 


3.00 


7.50 


6.00 


12.00 


8.00 


7.00 


8.00 


6.00 


6. 00 


6.00 


7.00 


7 . 50 


7.00 


7.00 


5.25 


5.00 


3.00 


3-00 


3 . 00 


3.00 


3.00 


: 3.00 


7.00 


6.00 


7.50 


6.00 


6.00 


7.50 


5.00 


5.00 


6.00 


5 - 50 


8.00 


6.00 


4.00 


3.00 


7.00 


5.00 


8 . 75 


7.00 


6.00 


7.00 


"■ : " 5.50 


7.00 


6.00 


7.00 


7.00 


7.00 


6.50 


5.00 


10.00 


7.50 


10.00 


12.00 


12.00 


10.00 


6.00 


5.00 


5.00 


5.00 


5.00 


6.00 


5.00 


3.00 


20.00 


16.00 


19.10 


20.00 


20.00 


20.00 


20.00 


52.30 


48.50 


52.50 


49.80 


52.50 







. .:■.■■ 



25.00 


01 


40.00 


02 




03 


12-80 


04 


19. 10 


05 


50.00 


06 


50.00 


07 


15.00 


08 


37.00 


09 


750.00 


10 


550.00 


11 


17.50 


12 


15.00 


13 


122.50 


14 


25.50 


15 




16 




17 


10.00 


18 


705.00 


19 


319.00 


20 


25.00 


21 


326. 70 


22 


446.60 


23 


300.00 


24 




25 




26 




27 




28 


650.00 


29 


600.00 


30 




31 




32 




33 




34 




35 




36 




37 


3.00 


38 


3.00 


39 


8.00 


40 


7 . 00 


41 


2.50 


42 


5.00 


43 


5.00 


44 


6.00 


45 


7.00 


46 


8.00 


47 


6.00 


48 


20.00 


49 




50 



13U 



1977 PREVAILING CHARGE SUMMARY DATA GROUP MEDICAL AND SURGICAL SERV. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



TEXAS 
LOCALITY DESIGNATION FOR SPECIALIST 



«:?■:■ 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



■'■ ' 



:>x-:teW ; : : : : : : ' : : : :-:" : .*: : :-: 



188 

12.00 
25.50 

7 . 70 

15.00 

19. 10 

44.70 

10.00 

20.00 

473.40 

541 .00 

10.00 

15.00 

102.10 

26.80 

405.80 

262.50 

12.50 

650.00 

255.00 

20.40 

270.50 

405.80 

255.20 

34.50 

14.00 

415.00 

541 .00 

473.40 

600.00 

19.10 

25.50 

15.00 

45.00 

39. OO 



6.50 

4.00 

8.00 

6.00 

4.00 

5.00 

5.00 

6.00 

7.00 

10.00 

4.00 

19.10 

52.50 



212 

15.00 
31 .90 

10.00 

19.10 

31 .90 

35.00 

10.00 

20.00 

473.40 

54 1 . 00 

12.50 

15.00 

102. 10 

30.00 

405.80 

262.50 

12.50 

600.00 

255.20 

35.00 

270.50 

500. CO 

238.00 

34 . 50 

15.00 

415.00 

541 .00 

473.40 

600.00 

1 5 . 00 

17.50 

19.10 

44.70 

38.30 



6.50 

3.00 

7.00 

5.00 

3.00 

6.00 

6.00 

6.00 

6.00 

10.00 

5.00 

17.50 

49.80 



220 

1 2 . 00 
30.00 

7.70 

15.00 

25.00 

31 .90 

10.00 

20.00 

589.50 

673.70 

15.00 

12.80 

126.30 

30.00 

475.00 

262-50 

12.50 

750.00 

300.00 

25.50 

380.00 

500.00 

262.50 

40.00 

15.00 

415.00 

640.00 

540.00 

525.00 

16.00 

27.50 

19.10 

45.00 

39.00 



6.50 

5.00 

7.00 

7.00 

5-00 

8. CO 

5-00 

7-00 

6-00 

15-00 

5-00 

19-10 

52.50 



221 

12.50 
30.00 

6.40 
7.50 
20.40 
31 .90 
10.20 
20.00 



226 



491 
561 



.30 
.40 



15.00 

14.00 
105.90 

25.50 
421 . 10 
262.50 

12.50 
701 .80 
255.20 

30.00 
280.70 
446.60 
225.00 

35 . 70 

14 .00 
415.00 



.40 
.30 



561 

491 

600 - 00 
1 5 . 00 
25.00 
19.10 
40 . 00 
22.30 



6.50 
4.00 
7.00 
7.00 
3.00 
6.00 
6.00 
00 
00 



6 

7 
12.00 

3.00 
19.10 
52.50 



188 



212 



220 



221 



226 



15.00 


25.00 


18.00 


17.50 


20.00 


01 


44.70 


44.70 


. 38.30 


31 .90 


44.70 


02 
03 


10.00 


12.80 


12.50 


10.00 


10.20 


04 


15.00 


19. 10 


19.10 


15.00 


1 1 . 90 


05 


31 .90 


35-00 


35.00 


30.00 


26.00 


06 


40.00 


40.00 


50.00 


31 .90 


50.00 


07 


7.00 


12.80 


12.80 


12.00 


8.90 


08 


50.00 


25.00 


17.50 


15.00 




09 


733.70 


638.00 


638.00 

600.00 

15.00 


650.00 




10 
11 
12 


15.00 


15.00 


15.00 


1 5 . 00 




13 


1 09 . 70 


150.00 


130.20 


113.60 




14 


25.00 


35.00 


31 .90 


44.70 




15 

16 
17 


10.00 


10-00 


10.00 


10.00 




18 


606.10 


600.00 


650.00 


695.00 




19 


350.00 


250.00 


3 1 9 . 00 


370.00 


■ 


20 


31 .90 


25-00 


30.00 


25.00 




21 


290.90 


191 .40 


3 1 9 . 00 


323.00 




22 


410.00 


446.60 


510.40 


478.50 




23 


287.10 


287.10 


300.00 
40.00 
12.00 
638.00 
638.00 
641 .40 


350.00 




24 
25 
26 
27 
28 
29 




mmmm 


525.00 


.:v- : : ; : : : : x : x : : : :y: : * 


■ 


30 






17.50 






31 






35.00 






32 






22.00 






33 






47.00 






34 






47.00 






35 












36 

37 


3.00 


3.00 


3.00 


3.00 


3.00 


38 


3-00 


3.00 


4.00 


3.00 


3.00 


39 


7.00 


8.50 


7.00 


7.00 


8.00 


40 


S.00 


7.50 


6.00 


7.00 


7.00 


41 


3.00 


2.00 


■ 2.50 


3.00 


3.00 


42 


5.00 


10.00 


7.00 


6-00 


7.50 


43 


3 . 00 


4.00 


5 . 00 % 


5.00 


5.00 


44 


5.00 


6-00 


6.00 


5.00 


7.00 


45 


5.00 


6.00 


6.00 


7.00 


7.00 


46 


10.00 


10.00 


10.00 


10.00 


10.00 


47 


5.00 


4.00 


5.00 


5.00 


5.00 


48 


19.10 


20.00 


19.10 


16.50 


20.00 


49 
50 



T\ 



135 



1977 PREVAILING CHARGE SUMMARY DATA GROUP MEDICAL AnD SURGICAL SERV. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

38 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



INITIAL 
INITIAL 
MINIMAL 
ROUTINE 
ROUTINE 
INITIAL 
INITIAL 
ROUTINE 
BIOPSY 



LIMITED OFFICE VISIT 

COMP OFFICE VISIT 

OFFICE VISIT 

BRIEF OFFICE VISIT 
HOME VISIT 
HOSPITAL VISIT 
HOSPITAL VISIT 
HOSPITAL VISIT 



BRIEF 
BRIEF 
COMP 
BRIEF 
SKIN 



RADICAL MASTECTOMY 

REDUCTION OF FRACTURE 

ARTHOTMY 

NEEDLE PUNCTURE OF BURSA 

BRONCHOSCOPY 

THORACENTESIS 

CATHETERIZATION 

INSERTION OF PACEMAKER 

BLOOD TRANFUSION 

COLECTOMY 

APPENDECTOMY 

SIGMOIDOSCOPY 

HEMORRHOIDECTOMY 

CHOLECYSTECTOMY 

REPAIR HERNIA 

CYSTOSCOPY 

DILATION OF URETHRA 

PROSTATECTOMY 

ELECTROSECTION OF PROSTATE 

HYSTERECTOMY 

EXTRACTION OF LENS 

X-RAY CHEST 

X-RAY SPINE 

X-RAY HIP 

X-RAY STOMACH 

X-RAY COLON 

CO 3.". L T 

RADIOTHERAPY 

HEMOGLOBIN 

WHITE CELL COUNT 

COMPLETE BLOOD COUNT 

CHOLESTERAL BLOOD COUNT 

HEMATOCRIT 

PROTHROMBIN 

SEDIMENTATION RATE 

BLOOD SUGAR 

BUN UREA NITRATE 

PAP TEST 

URINALYSIS 

ELECTROCARDIOGRAM 

ELECTROENCEPHALOGRAM 



227 

10.00 
30.00 

8.90 

15.30 

31 .90 

44.70 

12.00 

20.00 

446.60 

510.40 

12.00 

12.80 

95.70 

19.10 

382.80 

262.50 

12.50 

600.00 

223.30 

20.00 

255.20 

382.80 

200.00 

31 .90 

12.80 

415.00 

510.40 

446.60 

500.00 

15.00 

20.00 

20.00 

45.00 

39.00 



6.50 
5.00 
8.00 
5.00 
5.00 
6.00 
4.00 
7.50 
00 
00 
00 
10 



235 



240 

8.00 
20-00 

10.00 
15.00 
25.50 
30.00 
12.00 
20.00 

491 .30 

561 .40 
15.00 
14.00 

105.9C 
60. Of 

421 

262 



H 

50 



5 
11 

5 
19 
48.50 



12.50 

701 .80 

280.70 

35.00 

280.70 

421 .10 

250.00 

35.70 

14.00 

415.00 

561 .40 

650.00 

600.00 

15.00 

25.00 

20.00 

45.00 

39.00 



6.50 
4.00 
6.00 
7.00 
3-00 
6-00 
6-00 
6.00 
7.00 
7.50 
2.00 
18.00 
52.50 



243 

10.00 
18.00 

7.70 

12 .80 

19.10 

25.00 

10.00 

20.00 

527.00 

602.30 

12.00 

12.80 

13.60 

23.00 

451 .70 

262.50 

12.50 

750.00 

300 . 00 

23.00 

301 . 10 

600 . 00 

264. 10 

38.30 

15.00 

4 1 5 . 00 

602.30 

527.00 

600 . 00 

15.50 

23.00 

16.60 

45.00 

39-00 



50 
00 
50 
50 
00 
00 
00 



6.50 
6.00 
8.00 
4.50 
20.00 
49.80 



750 

10.00 
25.00 

7.00 

12.00 

19.10 

26.00 

10.00 

20.00 

491 .30 

510.40 

15.00 

15.00 

1 50 . 00 

25.00 

421 . 10 

200.00 

12.50 

446.60 

275.00 

25.00 

280.70 

446.60 

250.00 

40.00 

1 1 .00 

4 1 5 . 00 

561 .40 

491 .30 

446.60 

15.00 

25-00 

1 7 . 50 

44 . 70 

35.00 



00 

00 
00 
00 

00 



6.00 

5.00 

6.00 

6. 00 

12.00 

4.00 

19.10 

48.50 



TEXAS 
LOCALITY DESIGNATION FOR SPECIALIST 

227 235 240 243 750 



25.00 
50.00 

1 1 . 50 

15.00 

35.00 

50.00 

12.80 

26.80 

600.00 

608.70 

15.00 

1 5 . 00 

130.20 

26.80 



10.00 
600.00 
300 . 00 

25.00 
319.00 
500.00 
300.00 



650.00 
50.00 
35.00 
35.00 
22.0Q 
54.20 
50.25 



3.00 
3.00 
8.00 
7.50 
3.25 
7.00 
5.00 
7.50 
5.00 

10.00 
5.00 

19.10 



25.00 
750.00 



14.25 

127.60 

31.90 



10.00 

750.00 
287. 10 
31.90 
296.00 
510.40 
325.00 



10.00 


12.00 


01 


31.90 


30.00 


02 
03 


10.00 


8.90 


04 


12.80 


12.80 


05 


25.00 


25.50 


06 


44.70 


38.30 


07 


12.80 


10.00 


08 


15.00 


25.00 


09 


535.90 


750.00 


10 




510.40 


11 




15.00 


12 


15.00 


15.00 


13 


125.00 


175.00 


14 


50.00 


31 .90 


15 




500.00 


16 




250.00 


17 


10.00 


10.00 


18 


574.20 


638.00 


19 


255.20 


300.00 


20 


26.25 


25.00 


21 


306.20 


255.20 


22 


446.60 


480.00 


23 


255.20 


287.10 


24 




40.00 


25 




10.00 


26 




6 1 2 . 50 


27 




560.00 


28 




562.70 


29 




500.00 


30 




1 3 . 50 


31 




21.25 


32 




18.75 


33 




42.75 


34 




42.75 


35 
36 
37 


3.00 


3.0C 


38 


3.00 


3.00 


39 


7.50 


7.00 


40 


7.00 


6.00 


41 


3.00 


3.00 


42 


6.50 


6 . 00 


43 


5.00 


, 5.00 


44 


7.00 


6.00 


45 


7.00 


6.00 


46 


10.00 


10.00 


47 


5.00 


4.00 


48 


19.10 


19.10 


49 
50 



136 



1977 PREVAILING CHARGE SUMMARY DATA 



GROUP MEDICAL AND SURGICAL SERV. 



" 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 
770 790 



10.00 
,25 . 00 

6.40 

12.00 

19. 10 

32.00 

10.00 

22.00 

473.40 

450.00 

12.50 

12.80 

102. 10 

25.00 

405.80 

250 . 00 

12.00 

650.00 

275-00 

31 90 

.40 

.50 



10 


.00 


25 


.00 


6 


.40 


12 


.80 


25 


.00 


31 


.90 


10 


.00 


15 


.00 


650 


.00 


382 


.80 


15 


.00 


12 


.25 


125 


.00 


35 


.00 


451 


.70 


300 


.00 


12 


50 


752 


80 


280 


00 


25 


00 


301 


10 


425 


00 


255 


20 


40 


00 


10 


00 


382 


80 


575 


00 


527 


00 


550 


00 


15 


00 


25 


00 


19 


10 


35 


00 


37 


00 


3. 


00 


4 


00 


7. 


50 


7. 


00 


3. 


00 


6. 


00 


6. 


00 


7. 


00 


7. 


00 


10. 


00 


5. 


00 


19. 


10 


51 . 


00 



*91 

412 

250.00 

37.00 

10.00 

382.80 

600 . 00 

473.40 

550 . 00 

15.00 



21 
19 



00 
10 



40.00 
44.70 



5.00 
3.00 






7.00 

6.50 

4.00 

6.00 

5.00 

6.50 

7.00 

10.00 

4.00 

19.10 

51 .00 






TEXAS 






LOCALITY DESIGNATION 


FOR SPECIALIST 




770 


790 




12.80 


10.00 


01 


44.70 


40.25 


02 
03 


TO. 00 


7.70 


0< 


12.80 


15.00 


05 


31 .90 


31 .90 


06 


50.00 


35.00 


07 


12.00 


9.60 


08 


25.00 


15.00 


09 


510.40 


574.20 


10 


612.50 


638.00 


11 


25.50 


15.00 


12 


T5.00 


15.00 


13 


200.00 


127.60 


14 


50.00 


50.00 


15 


500.00 


425.00 


16 


300.00 


165.00 


17 


10.00 


10.00 


18 


600.00 


600.00 


19 


300.00 


250.00 


20 


35.00 


25.00 


21 


300.00 


290.00 


22 


446.60 


450.00 


23 


287. 10 


255.20 


24 


40.00 


37.00 


25 


10.00 


10.00 


26 


560.00 


638.00 


27 


510.40 


600.00 


28 


600.00 


571 .60 


29 


510. 40 


542.30 


30 


16.00 


16.50 


31 


25.00 


29.00 


32 


20.00 


21 .00 


33 


44.70 


48.00 


34 


41.50 


44.70 


35 
36 
37 


3.00 


3.00 


38 


4.00 


4.00 


39 


7.00 


7 . 00 


40 


7.00 


7.00 


41 


5.00 


4.00 


42 


6.00 


6.00 


43 


5.00 


5.50 


44 


7-00 


6.00 


45 


10.00 


7.00 


46 


10.00 


12.00 


47 


6.00 


5.00 


48 


19.10 


19.10 


49 
50 



137 



UTAH 




One Locality - Statewide 



138 



1977 PREVAILING CHARGE SUMMARY DATA B/S OF UTAH 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE 8RIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



: '. : : : ''' ■'■ 



UTAH 

9.90 

34.50 

5.10 

7.00 

12.00 

23.00 

49.00 

10.00 

20.70 

506-40 

595.40 

15.00 

15.30 

112.50 

28.00 

177.50" 

541 . 10 

32.80 

632.90 

20.00 

468.80 

235.00 

46.90 

15.00 

501 

491 

468.80 

459.50 

1 5 . 00 

23.00 

20.60 

38.30 

37.00 

21 .00" 



70 
.40 



3.00 
3.00 
8.00 
6.90 
3.00 
6.00 
3.75 



;MiMMM:>:\W-::lM-:x<:<«'x<x<««y 



6.00 

6.00 

10.00 

3.00 

20.00 

43.30 



UTAH 

LOCALITY DESIGNATION FOR SPECIALIST 

UTAH 

13.00 
.40.00 

5.60 

8.00 
15.00 
25.00 
49.00 
10.50 
18.80 

■ 540.00 • 

560.00 

16.00 

17.60 
112.50 

32.80 
1 77.50* 
577.00 

32.80 
650.00 

23.00 



420.00 

273.30 

50.00 

15.00 

510.40 

510.40 

500.00 

500.00 

13.80 

27.25 

25.50 

44.70 

44.70 

15.00 



■:-:.:vX-"';-:-:-XvX-:-:>:v:-:v:-;-:-:v:-: 



3.00 
3.00 
7.50 



00 
00 
00 
00 
40 
00 
10 
00 



19. 10 
44.70 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
IS 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
.i? 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



139 



VERMONT 







One Locality - Statewide 



1U0 



1977 PREVAILING CHARGE SUMMARY DATA NEW HAMPSHl RE- VERMONT B/S 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 



01 INITIAL LIM 

02 INITIAL COM 

03 MINIMAL OFF 

04 ROUTINE BRl 

05 ROUTINE BR I 

06 INITIAL BR I 

07 INITIAL COM 

08 ROUTINE BR I 

09 BIOPSY SKIN 

10 RADICAL MAS 

11 REDUCTION 

12 ARTHOTMY 

13 NEEDLE PUNC 

14 BRONCHOSCOP 

15 THORACENTES 

16 CATHETERIZA 

17 INSERTION 

18 BLOOD TRANF 

19 COLECTOMY 

20 APPENDECTOM 

21 SIGMOIDOSCO 

22 HEMORRHOIDE 

23 CHOLECYSTEC 

24 REPAIR HERN 

25 CYSTOSCOPY 

26 DILATION OF 

27 PROSTATECTO 

28 ELECTROSECT 

29 HYSTERECTCM 

30 EXTRACTION 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 
X-RAY STOMA 
X-RAY COLON 

36 COBALT 

37 RADIOTHERAP 

38 HEMOGLOBIN 

39 WHITE CELL 

40 COMPLETE BL 

41 CHOLESTERAL 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATI 

45 BLOOD SUGAR 

46 BUN UREA NI 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARD 

50 ELECTROENCE 



ITED OFFICE VISIT 
P OFFICE VISIT 
ICE VISIT 
EF OFFICE VISIT 
EF HOME VISIT 
EF HOSPITAL VISIT 
P HOSPITAL VISIT 
EF HOSPITAL VISIT 

TECTOMY 

F FRACTURE 

TURE OF BURSA 

Y 

IS 

TION 

F PACEMAKER 

USION 






34 
35 



Y 
PY 

CTOMY 

TOMY 

IA 



URETHRA 
MY 

ION OF PROSTATE 
Y 
OF LENS 



CH 



COUNT 
OOD COUNT 
BLOOD COUNT 



ON RATE 
TRATE 



IOGRAM 
PHALOGRAM 



02 

10-00 

25.00 

5.00 

8.00 

12.00 

26.00 

30.00 

9.00 

19.10 



10.00 



20.00 



11 .00 

250.00 
25.00 

435.00 
250.00 
1 00 . 00 



2.10 
3.50 
7.00 
5.00 
3.00 
6.00 



50 
00 

00 



. ■ :■■::,■ 



VERMONT 
LOCALITY DESIGNATION FOR SPECIALIST 

02 



15.00 

31 .90 

6.00 

10.00 

1 2 . 80 

30.00 

40.00 

10.00 

25.00 

500.00 

638.00 

18.00 



95.70 
25.00 



25.00 
500.00 
275.00 

23.00 

446.60 

261.00 

75.00 

560.00 

560.00 

500.00 

500.00 

4.50 

23.00 

5. 00 

17.50 

16.50 

7.00 

13.00 

3.00 

2.00 

8.00 

5.00 

3.00 

3.50 

4.00 



8.00 

3.00 

20.00 



00 
50 
00 
00 



20.00 
25.50 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



lUi 



VIRGINIA 





INDEPENDENT 


CITIES 




ALEXANDRIA 


;o 


LCllNGTON 




BED'ORO 


? i 


LVNLHRIIRO 




BRISTOL 


22 


MARTINSVILLE 




BUENA VISTA 


23 


NEWPORT NEWS 




CHARLOTTESVILLE 


r4 


NORIOLK 




CMF.SAPrAKE 


25 


NOR ION 




cm ton roitGE 


M 


PLTtH'iRIJRG 




COLONIAL HEIGHTS 


17 


PORT* MOUTH 




COV'NGfON 


m 


RAOI OMD 


to 


OANVILLE 


19 


RICHMOND 




I Mf'ORIA 


>0 


ROANOKE 




Mim*l 


II 


SALEM 




FALLS CHURCH 


12 


SOUTH BOSTON 




FRANKLIN 


U. 


STAUNTON 




FRLOCftiCKMUM 


14. 


surroL* 


It 


GALAI 


IS 


VIRGINIA BEACH 


IT 


HAMPTON 


1 


WAYNESBORO 


»• 


HARRISONBUM 


17 


WILLIAMSBURG 


Tt 


hopcwui 


N 


WINCHESTER 




Four Localities: 

01- Richmond metropolitan aroa and Charlottesville - Henrico, Chesterfield, 

and Albemarle Counties. 

02- Tidewater and Northern Virginian Counties - Loudon, Fauquier- 

Prince William, James City, York Counties and 
the Suffolk, Portsmouth, Norfolk, Chesapeake, 
Virginia City area. 



0>* Small towns and industrial - Washington, Henry, Pittsylvania, 
Halifax, Greensville, Campbell, Bedford, Roanoke, 
Montgomery, Alleghany, Rockbridge, Augusta, Greene, 
Rockingham, Page, Madison, Culpeper, Rappahannock, 
Shenandoah, Warren, Frederick, Clarke, Stafford, and 
Spotsylvania Counties. 

04- Extremely rural - all other Counties. 

(Note: Alexandria, Arlington, and Fairfax are carried by the 
Washington D.C. carrier.) 

ih2 



1977 PREVAILING CHARGE SUMMARY DATA THE TRAVELERS INSURANCE COMPANY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION AREA 1 AREA 2 

01 INITIAL LIMITED OFFICE VISIT 12.80 10.00 

02 INITIAL COMP OFFICE VISIT 31.90 30.00 

03 MINIMAL OFFICE VISIT 8.90 8.90 

04 ROUTINE BRIEF OFFICE VISIT 8.90 8.90 

05 ROUTINE BRIEF HOME VISIT 12.80 12.80 

06 INITIAL BRIEF HOSPITAL VISIT 31.90 31.90 

07 INITIAL COMP HOSPITAL VISIT 31.90 31.90 

08 ROUTINE BRIEF HOSPITAL VISIT 11.50 8.90 

09 BIOPSY SKIN 21.00 21.00 

10 RADICAL MASTECTOMY 560.00 560-00 

11 REDUCTION OF FRACTURE 574.20 574.20 

12 ARTHOTMY 10.00 12.80 

13 NEEDLE PUNCTURE OF BURSA 15.00 15.00 

14 BRONCHOSCOPY 127.60 127.60 

15 THORACENTESIS 19.10 19.10 

16 CATHETERIZATION 225.00 225.00 

17 INSERTION OF PACEMAKER 625.00 625.00 

18 BLOOD TRANFUSION 6.40 6.40 

19 COLECTOMY 600.00 600.00 

20 APPENDECTOMY 300.00 300.00 

21 SIGMOIDOSCOPY 20.00 20.00 

22 HEMORRHOIDECTOMY 250.00 250.00 

23 CHOLECYSTECTOMY 446.60 446.60 

24 REPAIR HERNIA 287.10 287.10 

25 CYSTOSCOPY 42.00 42.00 

26 DILATION OF URETHRA 12.80 12.80 

27 PROSTATECTOMY 612.50 612.50 

28 ELECTROSECTION OF PROSTATE 612.50 612.50 

29 HYSTERECTOMY 500.00 500.00 

30 EXTRACTION OF LENS 500-00 500.00 

31 X-RAY CHEST 15.30 15.00 

32 X-RAY SPINE 25.00 24.00 

33 X-RAY HIP 24.00 24.00 

34 X-RAY STOMACH 51-00 51.00 

35 X-RAY COLON 48.00 48.00 

36 COBALT 17.90 17.90 

37 RADIOTHERAPY 31-90 31-90 

38 HEMOGLOBIN 3-00 3.00 

39 WHITE CELL COUNT 3.00 3.00 

40 COMPLETE BLOOD COUNT 8.00 7.50 

41 CHOLESTERAL BLOOD COUNT 5.85 5.50 

42 HEMATOCRIT 5.00 5.00 

43 PROTHROMBIN 5.00 6.00 

44 SEDIMENTATION RATE 5.00 4.00 

45 BLOOD SUGAR 5.00 5.00 

46 BUN UREA NITRATE 5.00 5.00 

47 PAP TEST 6.00 6.00 

48 URINALYSIS 3.00 3.00 

49 ELECTROCARDIOGRAM 19.10 18.00 

50 ELECTROENCEPHALOGRAM 51.00 51.00 



AREA 3 AREA 4 



VIRGINIA 
LOCALITY DESIGNATION FOR SPECIALIST 
AREA 1 AREA 2 AREA 3 AREA 4 



10.00 

22.00 

7.70 

7.70 

10.00 

25.50 

25.50 

7.70 

21 .00 

560.00 

574.20 

10.00 

10.00 

127.60 

25.00 

225.00 

625.00 

6.40 

600.00 

300.00 

19.10 

250.00 

446.60 

287.10 

42.00 

12.e0 

612.50 

612.50 

500.00 

500.00 

15.00 

24.00 

24.00 

51 .00 

48.00 

17.90 

31 

3. 

3. 



• 90 
.00 
.00 
8.00 
8.00 



3. 
5. 
4. 
5. 
7. 



.00 

.00 

.00 

.00 

.00 

8.00 

3.00 

15.00 

51 .00 



10.00 

23.00 

7.70 

7.70 

12.00 

25.50 

25.50 

8.85 

21 .00 
560.00 
574.20 

10.00 

10.00 
127.60 

1 9 10 
225.00 
625.00 
6.40 
600 . 00 
300 . 00 

20.00 
250.00 
446.60 
287. 10 

42.00 

14.60 
612.50 
612.50 
500 . 00 
500 . 00 

15.00 

22 . 30 
24 . 00 
51 .00 
48.00 
17.90 
31 .90 



.50 
.00 
.00 
00 
,00 



6.00 
6.00 
5 . 00 
5.00 
7.00 
3.00 
15.00 
51 .00 



15.00 


15.00 


1 2 - 80 


10.00 


01 


44.70 


44.70 


31 .90 


35.00 


02 


12.00 


12.00 


8 . 90 


8.90 


03 


1 2 . 00 


12.00 


8 . 90 


8.90 


04 


18.00 


19.10 


12.80 


12.00 


05 


50.00 


44.70 


38.30 


35.00 


06 


50.00 


44.70 


38.30 


35.00 


07 


12.00 


12.80 


8.90 


8.90 


08 


25.50 


25.00 


25.50 


25.50 


09 


600.00 


560.00 


510.40 


574.20 


10 


574.20 


574.20 


542.30 


510.40 


11 


15.00 


12.80 


12.00 


1 2 . 80 


12 


15.00 


14.00 


12.80 


12.80 


13 


125.0Q 


134.00 


125.00 


100.00 


14 


44.70 


60.00 


35.00 


44.70 


15 


225.00 


225.00 


225.00 


225.00 


16 


625.00 


625.00 


625.00 


625.00 


17 


6.40 


6.40 


6.40 


6.40 


18 


600.00 


648.00 


574.20 


579.30 


19 


287.10 


300.00 


300.00 


300.00 


20 


23.00 


30.00 


21.70 


25.00 


21 


255.20 


245.00 


220.00 


175.00 


22 


478.50 


500.00 


446.60 


396.80 


23 


299.90 


300.00 


264. 10 


250.00 


24 


38.30 


55.00 


40.00 


36.00 


25 


10.00 


12.00 


12.80 


10.00 


26 


720.00 


574.20 


560.00 


446.60 


27 


612.50 


612.50 


574.20 


395.60 


28 


450.00 


500.00 


477.20 


477.20 


29 


550.00 


500.00 


450.00 


500.00 - 30 


18.50 


1 2 . 00 


12-80 


13.50 


31 


27.00 


18.00 


3 1 . 90 


27.00 


32 


24.90 


24.00 


25.50 


25.50 


33 


57.00 


48.00 


50.00 


50 . 00 


34 


48.00 


42.00 


44.70 


45.00 


35 


19.10 


19. 10 


19. 10 


19.10 


36 


31 .90 


31 .90 


31 .90 


31 .90 


37 


3.00 


2.00 


2.00 


3.00 


38 


3.00 


2.00 


3.00 


3.00 


39 


8.00 


8.00 


8.00 


7 . 00 


40 


6.00 


5 . 00 


6.00 


7.00 


41 


3.00 


3.00 


3.00 


3.00 


42 


5.00 


5.00 


5.00 


5.00 


43 


5.00 


3.00 


3.00 


3.50 


44 


6 . 00 


5.00 


:;;: 5.00 


6.00 


45 


6.00 


5.00 


5.00 


6.00 


46 


6.00 


6.00 


6.00 


6.00 


47 


5.00 


4.00 


3.00 


3.75 


48 


19.10 


19.10 


16.00 


16.00 


49 


50.00 


38.30 


50.00 


51.00 


50 



lU3 



WASHINGTON 




Four Localities: 

01 - Seattle-Washington Physicians Service, 18 bureaus - rest of State 

02 - King County Medical Blue Shield - King County 

03 - (MSCEW) - Spokane and Richland-Pasco-Kennewick metropolitan areas 

(FOR GENERAL FRACTIONER ONLY) 
OU - Medical Service Corporation of Eastern Washington - Adams, Benton, Ferry, Franklin, Grant, 
Lincoln, Okanogan, Pend Oreille, Spokane, Stevens, and Whitman Counties 



ikk 



1977 PREVAILING CHARGE SUMMARY DATA 



WASHINGTON PHYSICIANS SERVICE 



WASHINGTON 



LOCALITY DESIGNATION FOR GENERAL PRACTICE 



LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 



02 



04 



01 



03 



02 



04 



01 



03 



01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 
X-RAY STOMACH 
X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



34 
35 



12.80 

38.30 

6.00 

10.00 

19.20 

25.00 

38.30 

12.80 

25.00 

648.00 

360.00* 

18.50 

17.50 

135.00 

31 .90 

150.00 

510. SO 

3.50 

648.00 

325.00 

25.00 

252.00 

493.00 

306.00 

38.30 

19.20 

700.00 

714.80 

600.00 

638.20 

16.00 

22.50 

17.50 

40.00 

52.50 

27.50 

27.50 

3.00 

3.00 

8.00 

6.00 

3.00 

6.00 

4.00 

6.50 

7.00 

10.00 

4.00 

20.00 

55.00 



11 

31 

5 

9 



00 
90 
60 
00 



15.00 

24.00 

40.00 

9.60 



22.00 
15.00 



20.10 
250.00 



22.00 



3.30 

4.00 

9.10 

10.00 

4.00 

8.50 

5.10 

: 8.50 

8.30 

8.00 

4. 10 

20.70 



12.40 

38.30 

7.50 

8.90 

15.30 

24.30 

46.00 

8.90 

23.70 



21 .00 
15.30 

26.00 



24.00 

450.00 
268.00 



15.30 
23.00 
26.25 
49.00 
43.10 



3.00 
3.00 
8.90 
7.50 
3.00 
6.00 
4.80 
7 . 50 
6.60 
9.00 
4.00 
23.00 



11 .00 
31 .30 
5.00 
9.00 
15.00 
24.60 
36.30 
10.00 
20. 10 



18.00 
14.00 

25.00 



20.00 

232.40 
20.10 



22.00 
24.00 
25. 10 



3.30 
3.30 
9.10 
9.90 
3.50 
8.30 
5. 10 
8.30 
8.30 

10.00 
4. 10 

22.50 



. ■ :." ■-■■■ 



15.00 


11.00 


12.80 


44.70 


44.70 


. 47.90 


6.00 


4.00 


8.40 


10.90 


10.00 


10.20 


19.20 


16.50 


19.20 


25.00 


40.00 


28.50 


44.70 


50.00 


46.00 


12.80 


1 1 .50 


1 1 .50 


25.00 


21 .50 


25.80 


650.00 




536. 10 


365.00* 


660.00 


714.80 


19.20 


22.70 


16.00 


16.00 


16.00 




135.00 


180.00 


114.90 


27.50 




23.80 


150.00 






510.60 


801 .20 




3.50 






630.00 


610.00 


640.00 


325.00 




342.00 


25.00 


24.00 


25.00 


250.00 




231 .00 


525.00 


475.00 


507.50 


3 1 5 . 00 


270.00 


312.70 


38.30 


35.00 


40.00 


19.20 


18.00 


22.90 


700.00 


580.00 


700.00 


7 1 4 . 00 


580.00 


700.00 


600.00 




594.00 


638.20 


600 . 00 


638.20 


17.75 


24.00 


1 2 . 00 


31 .00 


25.00 


25 . 50 


16.00 


22.50 


30.60 


53.60 


46.00 


51.10 


55.00 


42 . 50 


48.50 


27.50 






27.50 




30.60 


3.00 


3.30 


2.80 


3.00 


3-30 


2.75 


8.00 


9.00 


8.00 


6.00 


9.00 


7.00 


3.00 


3.50 


: 2.80 


6.00 


8.30 


: 6.00 


4.0Q 


4.50 


:'.• 4.20 


6.00 


7.00 


7.50 


6.50 


7.00 


6.50 


8.00 


6.90 


9.30 


4.00 


4. 10 


4.00 


20.00 


20.70 


23.00 


55.00 




75.00 



01 
02 
03 
04 
05 
06 
07 

oe 

09 
10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



1U5 



WEST VIRGINIA 




Five Localities: 

16 - Charleston 

17 - 'Wheeling 

18 - Eastern Valley 

19 - Ohio River Valley 

20 - Southern Valley 



1U6 



1977 PREVAILING CHARGE SUMMARY DATA NATIONWIDE MUTUAL INSURANCE CO. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



WEST VIRGINIA 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 



16 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 

11 

12 
13 
14 
15 

16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



INITIAL LIMITED OFFICE VISIT 15.00 

INITIAL COMP OFFICE VISIT 30.00 

MINIMAL OFFICE VISIT 3.00 

ROUTINE BRIEF OFFICE VISIT 8.00 

ROUTINE BRIEF HOME VISIT 15.00 

INITIAL BRIEF HOSPITAL VISIT 25.50 

INITIAL COMP HOSPITAL VISIT 31.90 

ROUTINE BRIEF HOSPITAL VISIT 8.90 

BIOPSY SKIN 15.00 

RADICAL MASTECTOMY 575.00 

REDUCTION OF FRACTURE 510.40 

ARTHOTMY 19.10 

NEEDLE PUNCTURE OF BURSA 18.00 

BRONCHOSCOPY 127.60 

THORACENTESIS 30.00 

CATHETERIZATION 319.00 

INSERTION OF PACEMAKER 765.60 

BLOOD TRANFUSION 13.20 

COLECTOMY > 625.00 

APPENDECTOMY 250-00 

SIGMOIDOSCOPY 30.00 

HEMORRHOIDECTOMY 270.00 

CHOLECYSTECTOMY 497.60 

REPAIR HERNIA 287.10 

CYSTOSCOPY 50.00 

DILATION OF URETHRA 15.00 

PROSTATECTOMY 600.00 
ELECTROSECTION OF PROSTATE 480.00 

HYSTERECTOMY 574.20 

EXTRACTION OF LENS 550.00 

X-RAY CHEST 15.00 

X-RAY SPINE 20.00 

X-RAY HIP 25.00 

X-RAY STOMACH 31 .90 

X-RAY COLON 37.00 

COBALT 15.00 

RADIOTHERAPY 15.00 

HEMOGLOBIN 3.00 

WHITE CELL COUNT 3.00 

COMPLETE BLOOD COUNT 15.00 

CHOLESTERAL BLOOD COUNT 10.00 

HEMATOCRIT 4.00 

PROTHROMBIN 8.00 

SEDIMENTATION RATE 5.00 

BLOOD SUGAR 8.00 

BUN UREA NITRATE 10.00 

PAP TEST 7.00 

URINALYSIS 7.00 

ELECTROCARDIOGRAM 15.50 

ELECTROENCEPHALOGRAM 44.70 



17 

20.00 

25.00 

2 .00 

7.70 

12.80 

23.70 

25.00 

7.70 

19.10 

575.00 

510.40 

12.80 

15.00 

127.60 

30.00 

319.00 

765.60 

10.00 

625.00 

250.00 

25.00 

270.00 

400.00 

250.00 

50.00 

15.00 

600.00 

446.60 

574.20 

550.00 

20.00 

19.10 

25.00 

31.90 

37.00 

15. CO 

15.00 



.00 
.50 
.00 
.00 
.50 
.00 



5.00 



.00 
.00 



10.00 

3.00 

15.00 

44.70 



18 

12.00 

30 . 00 

5.00 

7.70 

10.00 

25.50 

28.00 

7.70 

19.10 

575.00 

510.40 

18.00 

18.00 

127.60 

30.00 

319.00 

765.60 

13.20 

625.00 

250.00 

25.00 

270.00 

497.60 

287.10 

50.00 

15.00 

600.00 

446.50 

574.20 

550.00 

20.00 

19.10 

25.00 

31 .90 

37.00 

15.00 

15.00 

3.00 

3.00 

6-00 

5.00 

3.00 

4.00 

5.00 

5.00 

5.50 

8.00 

3.00 

19.10 

44.70 



19 

12 .80 
32.00 
3.00 
6.40 
12.00 
20 .40 



.90 
.70 



31 

7. 

19.10 

575.00 

510.40 

12.80 

18.00 

127.60 

31 -90 

319.00 

765.60 

13.20 

625.00 

250.00 

31 .90 

270.00 

433.80 

287. 10 

50.00 

15.00 

600.00 

446.60 

574.20 

550 . 00 

20.00 

35 . 00 

25.00 

45.00 

37.00 

15.00 

15.00 

4.00 

3.00 

8 . 00 

6.00 

3.00 

6.00 

2.00 

6 . 00 

8.00 

10.00 

3.00 

20.00 

44.70 



20 

12.80 

32.00 

3.00 

7 . 70 

12.80 

23.00 

20.00 

8.90 

19. 10 

575.00 

5 1 . 40 

15.00 

6.00 

127.60 

30.00 

319.00 

765.60 

13.20 

625.00 

250-00 

26.00 

270.00 

497.60 

287. 10 

50.00 

15.00 

600.00 

446.60 

574.20 

550.00 

15.00 

24.40 

25.00 

40.00 

37.00 

15.00 

15.00 

3.00 

2.50 

8.00 

8.00 



00 
00 
00 
50 



8.00 
11-00 

4.00 
15.30 
44.70 



16 

15.30 

50.00 

3.00 

10.20 

20.00 

44.70 

50.00 

10.20 

25.00 

540.00 

574.20 

18.00 

12.80 

127.60 

31 .90 

191 

574. 

10.00 

600.00 

300.00 

30.00 

261 .00 

450.00 

270.00 

45.00 

15.00 

600.00 

612.50 

574.20 

510.40 

15.00 

25.50 

23.00 

31 .90 

35.00 

14.00 

14.00 

4.00 

2.00 

8.00 

8.00 



,40 
.20 



00 
00 
00 
00 



8.00 



17 

19. 10 

38-30 

4.00 

10-00 

15-00 

31 .90 

25.00 

10.00 

15.00 

500.00 

587.00 

25.50 

12.80 

125.00 

44.70 

191 .40 

574.20 

13.20 

600.00 

300.00 

19. 10 

300.00 

382.80 

225.20 

44. 70 

12.80 

600.00 

560.00 

525.00 

500.00 

21 .00 

v 35-00 

23.00 

42.00 

30.00 

14.00 

23.00 

3.00 

2.25 

9.75 

8.00 



.00 
,00 
.00 
.25 
.00 



7 

5 

19 



00 
00 
10 



51.00 



10-00 

4.00 

20.00 

51 .00 



18 

15.00 

35.00 

5.00 

9.00 

19. 10 

40.00 

40.00 

12.00 

27.50 

600.00 

638.00 

19.10 

12.80 

127.60 

44.70 

191 .40 

574.20 

13.20 

638.00 

300.00 

25.00 

300.00 

450.00 

3 1 9 . 00 

50.00 

15.30 

600.00 

480.00 

574.20 

500.00 

10.20 

19.10 

23.00 

25.50 

25.50 

14.00 

23.00 

3.00 

3.00 

9.00 

5.00 

2.00 

5.00 

■ 4.00 

6.00 

6.00 

8.00 

3.00 

19. 10 

51 .00 



19 

12.80 

28.00 

3.00 

10-00 

15.00 

29.30 

35.00 

10.00 

25.00 

430.00 

455.00 

12.80 

12.80 

100.00 

30.00 

191 .40 

574.20 

15.00 

580.00 

300.00 

25.00 

175.00 

433.80 

265.00 

25.50 

15.00 

510.40 

510.40 

574.20 

500.00 

18.00 

9.50 

19.10 

20.00 

21 .00 

11 .50 

33.00 



20 



.00 
.00 
.00 
.00 
.50 
.00 
.00 
.00 
.00 
.00 
,00 



11 .25 

33. 10 

3.00 

10.00 

12.00 

25.00 

24.00 

8.00 

27.50 

600.00 

600.00 

19. 10 

12.80 

100.00 



.90 

.40 



15.00 
51 .00 



31 

1 91 

574.20 

13.20 

520.00 

300.00 

25.50 

300.00 

382.80 

255.20 

40.50 

15.00 

600.00 

528.00 

574.20 

497.60 

15.30 

30.00 

26.00 

51 .00 

44. 70 

14.00 

23.00 

2.20 

3.00 

6.00 

5.00 

2.00 

5.00 

3.00 

6.00 

5.00 

8.00 

3.00 

19. 10 

51 .00 



01 
02 
03 
04 
05 
06 
07 
08 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



1U7 



WISCONSIN 




Eleven Localities: 
Surgical Care - Blue Shield Wisconsin - A 
Wisconsin Physicians Service - B, C, D, E, F, 

G } Hj 1; J f K 

(For more locality information see Appendix A) 



ll+8 



1977 PREVAILING CHARGE SUMMARY DATA MEDICAL SOCIETY OF MILWAUKEE CO. 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



WISCONSIN 
LOCALITY DESIGNATION FOR SPECIALIST 



PROCEDURE DESCRIPTION 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



INITIAL LIMITED OFFICE VIS 

INITIAL COMP OFFICE VIS 

MINIMAL OFFICE VISIT 

ROUTINE BRIEF OFFICE VISIT 

ROUTINE BRIEF HOME VISIT 

INITIAL BRIEF HOSPITAL VIS 

INITIAL COMP HOSPITAL VIS 

ROUTINE BRIEF HOSPITAL VIS 

BIOPSY SKIN 

RADICAL MASTECTOMY 

REDUCTION OF FRACTURE 

ARTHOTMY 

NEEDLE PUNCTURE OF BURSA 

BRONCHOSCOPY 

THORACENTESIS 

CATHETERIZATION 

INSERTION OF PACEMAKER 

BLOOD TRANFUSION 

COLECTOMY 

APPENDECTOMY 

SIGMOIDOSCOPY 

HEMORRHOIDECTOMY 

CHOLECYSTECTOMY 

REPAIR HERNIA 

CYSTOSCOPY 

DILATION OF URETHRA 

PROSTATECTOMY 

ELECTROSECTION OF PROSTATE 

HYSTERECTOMY 

EXTRACTION OF LENS 

X-RAY CHEST 

X-RAY SPINE 

X-RAY HIP 

X-RAY STOMACH 

X-RAY COLON 

COBALT 

RADIOTHERAPY 

HEMOGLOBIN 

WHITE CELL COUNT 

COMPLETE BLOOD COUNT 

CHOLESTERAL BLOOD COUNT 

HEMATOCRIT 

PROTHROMBIN 

SEDIMENTATION RATE 

BLOOD SUGAR 

BUN UREA NITRATE 

PAP TEST 

URINALYSIS 

ELECTROCARDIOGRAM 

ELECTROENCEPHALOGRAM 



IT 
IT 



IT 
IT 
IT 



: 



MILWAUK 

15-00 

30.00 

8.90 

8.90 

15.00 

30.00 

44.70 

12.80 

24.00 

535.90 

535.90 

1 5 . 00 

31 .60 

191 .40 

53.60 

160.00* 

562.50* 

689.00 

3 1 5 . 00 

35.00 

268.00 

459.40 

269.60 

76.60 

12.80 

612.50 

612.50 

574.20 

612.50 

15.80 

25.50 

24.00 

45.00 

38.30 

10.00 

4.00 

5.00 

10.00 

7. 10 

5.00 

7.00 

5.00 

7.00 

7.00 

8.00 

5.00 

20.00 

50.00 






wmtmM 



MILWAUK 

13.00 

38.30 

10.00 

12.00 

17.50 

35.00 

44.70 

13.40 

22.00 

560.00 

5 1 . 40 

19.10 

24.00 

191 .40 

44.70 

160.00* 

562.50* 

720.00 

3 1 5 . 00 

35.00 

280.00 

478.50 

280.00 

68.00 

12.00 

625.20 

612.50 

574.20 

632.00 

5.10 

1 . 20 

7.00 

19. 10 

17.90 

12.80 



5. 

4. 

12. 

6. 

4. 



00 
00 
00 
00 
00 



8.00 
4.00 
6.00 
6.00 
8.50 
5.00 
20.00 
13.00 



01 

02 

03 

04 

05 

06 

07 

08 

09 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

49 

50 



1U9 



1977 PREVAILING CHARGE SUMMARY DATA 



WISCONSIN PHYSICIANS SERVICE 



PROCEDURE DESCRIPTION 



LOCALITY DESIGNATION FOR 
B-12 C-13 D-14 



GENERAL PRACTICE 
K-15 E-19 



WISCONSIN 
LOCALITY DESIGNATION FOR SPECIALIST 



B-12 



C-13 



D-14 



K-15 



E-19 



01 INITIAL LIMITED OFFICE VISIT 


12.00 


12.80 


15.00 


15.00 


14.00 


12.60 


9.00 


16.00 


32.50 


37.20 


01 


02 INITIAL COMP OFFICE VISIT 


30.00 


25.20 


30.00 


30 . 00 


25-00 


45.00 


35.30 


- 40.00 


40.00 


44.70 


02 


03 MINIMAL OFFICE VISIT 


3.80 


3.00 


4.00 


■ 5.00 


3.00 


6.00 


3.80 


4.00 


6.00 


5.30 


03 


04 ROUTINE BRIEF OFFICE VISIT 


7.70 


7.70 


7.50 


7.70 


7.20 


7.7Q 


8.90 


8.00 


10.00 


10.20 


04 


05 ROUTINE BRIEF HOME VISIT 


10.00 


10.00 


1 2 . 00 


15.00 


12.80 


11.00 


8.90 


15.30 


16.10 


5.20 


05 


06 INITIAL BRIEF HOSPITAL VISIT 


22.00 


19. 10 


19. 10 


26.80 


20.00 


23.00 


19. 10 


31 .90 


42.00 


31 .90 


06 


07 INITIAL COMP HOSPITAL VISIT 


46.00 


40.00 


40.00 


85.60 


45.90 


45.00 


63.00 


50.00 


47.60 


44.70 


07 


08 ROUTINE BRIEF HOSPITAL VISIT 


7.70 


7.70 


6.00 


7.70 


7.70 


7.70 


7.00 


7.70 


10.00 


8.90 


08 


09 BIOPSY SKIN 


19.10 


17.00 


15.30 


19.10 


24.20 


19.10 


21 .00 


19. 10 


25.00 


19.00 


09 


10 RADICAL MASTECTOMY 


446-60 


528.00 


528.00 


528.00 


528.00 


530.60 


490.00 


535.90 


630.00 


577.50 


10 


11 REDUCTION OF FRACTURE 


570.00 


478.50 


540.00 


540 . 00 


446.60 


623.60 


612.50 


612.50 


714.60 


742.50 


1 1 


12 ARTHOTMY 


12.80 


12.00 


8.90 


12.80 


14.00 


24.40 


22.00 




20.00 


19. 10 


12 


13 NEEDLE PUNCTURE OF BURSA 


10.00 


14.00 


15.00 


18.00 


15.30 


12.80 


14.00 


12.00 


20.00 


20.40 


13 


14 BRONCHOSCOPY 












95.70 


1 14. 80 


1 14.80 


135.00 


1 5 . 00 


14 


15 THORACENTESIS 


25.50 


31 .90 


25.50 


25.50 


31 .90 


31.90 


21 .00 


20.00 


31 .90 


50.00 


15 


16 CATHETERIZATION 












220.00 


220.00 


220.00 


210.00 


206.30 


16 


17 INSERTION CF PACEMAKER 












638.00 


765.60 


765.60 


893.20 


893.20 


17 


18 BLOOD TRANFUSION 


10.00 


10.00 


7.50 


10.00 


10. 00 


10.50 


15.00 


8.50 


17.90 


15.00 


18 


19 COLECTOMY 


570.00 


612.50 


612.50 


685.00 


685.00 


560.00 


612.50 


612.50 


714. 60 


660.00 


19 


20 APPENDECTOMY 


283.00 


306.20 


306.20 


320.00 


285-00 


274.30 


280.00 


306.20 


360.00 


330.00 


20 


21 SIGMOIDOSCOPY 


20.00 


25.50 


20.00 


23.00 


23-00 


20.00 


31 .90 


25.00 


25.50 


31 .90 


21 


22 HEMORRHOIDECTOMY 


2 1 . 00 


240.00 


229.70 


240 . 00 


2 1 . 00 


195.00 


229.70 


245.00 


270.00 


288.80 


22 


23 CHOLECYSTECTOMY 


456.00 


535. SO 


453.00 


480.00 


450.00 


363.70 


459.40 


459.40 


540.00 


495.00 


23 


24 REPAIR HERNIA 


266.00 


268.00 


229.70 


297.50 


280.00 


250.00 


280.00 


255.20 


315.00 


288.80 


24 


25 CYSTOSCOPY 












31.90 


38.30 


38.30 


38.30 


41 .30 


25 


26 DILATION OF URETHRA 


10.00 


12.00 


12.80 


17.90 


15.00 


18.00 


12.00 


12.00 


1 1 .50 


12.40 


26 


27 PROSTATECTOMY 


450.00 


450.00 


450.00 


450.00 


4 50.00 


510.40 


612.50 


612.50 


612.50 


660.00 


27 


28 ELECTROSECTION OF PROSTATE 


612.50 




612.50 


632.00 


632.00 


510.40 


612.50 


612.50 


612.50 


660.00 


28 


29 HYSTERECTOMY 


446.60 


459.40 


459.40 


560 . 00 ' 


560.00 


446.60 


535.90 


535.90 


625.20 


600.00 


29 


30 EXTRACTION OF LENS 












450.00 


612.50 


560.00 


574.20 


612.50 


30 


31 X-RAY CHEST 


12.00 


13.50 


10.00 


15.00 


1 4 . 00 


5.00 


6.00 


6.00 


6.00 


6 . 50 


31 


32 X-RAY SPINE 


25.50 


24.00 


20-00 


30.40 


23.00 


7.50 


10.00 


10.00 


10.00 


10.00 


32 


33 X-RAY HIP 


14.00 


23.80 


20.00 


23.80 


23.80 


9.20 


9.00 


9.00 


7.70 


7.80 


33 


34 X-RAY STOMACH 


25.00 


30.00 


25.50 


40.00 


44.00 


15.00 


20.00 


20.00 


17.50 


2 1 . 00 


34 


35 X-RAY COLON 


35.00 


31 .90 


25.50 


47.00 


39-60 


15.00 


18.00 


18.00 


17.00 


21 .80 


35 


36 COBALT 












10.00 


10.00 


10.00 


9.00 


17.70 


36 


37 RADIOTHERAPY 












15.00 


15.00 


15.00 


12.00 


12.10 


37 


38 HEMOGLOBIN 


3.00 


3.50 


3.00 


3.20 


3.00 


3.00 


2.00 


2.50 


3.00 


3.30 


38 


39 WHITE CELL COUNT 


3.00 


3.50 


3.00 


3.20 


3.30 


3.50 


3.00 


2.50 


3.00 


3.30 


39 


40 COMPLETE BLOOD COUNT 


10.00 


6.00 


8.00 


8.80 


10.80 


8.00 


6.00 


8.00 


12.00 


9.80 


40 


41 CHOLESTERAL BLOOD COUNT 1 


7.00 


6.00 


5.50 


8.00 


6.60 . 


7.50 


5.50 


6.00 


6.00 


7.00 


41 


42 HEMATOCRIT 


2.50 


3.00 


5.00 


3.00 


3.00 


3. 50 


1 .80 


2.50 


3.00 


2.90 


42 


43 PROTHROMBIN 


5.00 


5.50 


4.40 


5.50 


5.00 


5.00 


5.00 


5.00 


5.30 


: 5.10 


43 


44 SEDIMENTATION RATE 


4.00 


2.00 


5-00 


4.30 


4.50 


4.00 


4.00 


4.00 


4.20 


" 4.50 


44 


45 BLOOD SUGAR 


8.00 


5.50 


5.00 


6.00 


6.00 


7.00 


5.00 


7.00 


7.00 


6.00 


45 


46 BUN UREA NITRATE 


6.00 


5.00 


6.00 


5.50 


5.00 


7.00 


5.50 


1 .00 


6.00 


6.20 


46 


47 PAP TEST 


7.00 


6.00 


8.00 


4.50 


7.00 


7.00 


7.50 


7.00 


7.00 


6.60 


47 


48 URINALYSIS 


3.00 


3.50 


3.00 


4.40 


4.00 


3.50 


3.00 


3.00 


4.20 


4.50 


48 


49 ELECTROCARDIOGRAM 


20.00 


17.00 


15.00 


18.00 


21 .00 


20.00 


16.00 


16.00 


18.50 


17.70 


49 


50 ELECTROENCEPHALOGRAM 


45.00 


45.00 


45.00 


45.00 


45.00 


47.10 


47.10 


47. 10 


50.00 


47.10 


50 



150 



PROCEDURE DESCRIPTION 

01 INITIAL LIMITED OFFICE VISIT 

02 INITIAL COMP OFFICE VISIT 

03 MINIMAL OFFICE VISIT 

04 ROUTINE BRIEF OFFICE VISIT 

05 ROUTINE BRIEF HOME VISIT 

06 INITIAL BRIEF HOSPITAL VISIT 

07 INITIAL COMP HOSPITAL VISIT 

08 ROUTINE BRIEF HOSPITAL VISIT 

09 BIOPSY SKIN 

10 RADICAL MASTECTOMY 

11 REDUCTION OF FRACTURE 

12 ARTHOTMY 

13 NEEDLE PUNCTURE OF BURSA 

14 BRONCHOSCOPY 

15 THORACENTESIS 

16 CATHETERIZATION 

17 INSERTION OF PACEMAKER 

18 BLOOD TRANFUSION 

19 COLECTOMY 

20 APPENDECTOMY 

21 SIGMOIDOSCOPY 

22 HEMORRHOIDECTOMY 

23 CHOLECYSTECTOMY 

24 REPAIR HERNIA 

25 CYSTOSCOPY 

26 DILATION OF URETHRA 

27 PROSTATECTOMY 

28 ELECTROSECTION OF PROSTATE 

29 HYSTERECTOMY 

30 EXTRACTION OF LENS 

31 X-RAY CHEST 

32 X-RAY SPINE 

33 X-RAY HIP 

34 X-RAY STOMACH 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAPY 

38 HEMOGLOBIN 

39 WHITE CELL COUNT 

40 COMPLETE BLOOD COUNT 

41 CHOLESTERAL BLOOD COUNT 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATION RATE 

45 BLOOD SUGAR 

46 BUN UREA NITRATE 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARDIOGRAM 

50 ELECTROENCEPHALOGRAM 



ATA 


WISCONSIN 


PHYSICIANS SERVICE 




WISCONSIN 










OCALITY 


DESIGNATION FOR 


GENERAL PRACTICE 


LOCALITY 


DESIGNATION FOR 


SPECIALIST 




F-36 


G-40 


H-46 


1-54 


J-60 


F-36 


G-40 


H-46 


1-54 


J-60 




15.30 


" 1 5 . 30 


18.00 


15.00 


15.00 


15.00 


20.00 


. 20.00 


16.00 


16.00 


01 


30.00 


30.00 


30.00 


25.50 


29.40 


38 . 30 


35.00 


. 44.70 


38.30 


44.70 


02 


4.00 


3.80 


5.00 


3.80 


4.00 


6.40 


3.80 


' 5.10 


5.00 


5. 10 


03 


7.70 


6.40 


8.90 


7.70 » 


7.70 


7 . 70 


7.70 


10.00 


8.90 


9.00 


04 


12.80 


12.00 


15.00 


12 .80 


10. oo 


8.00 


12. 80 


1 8 . 00 


16.00 


15.00 


05 


23.00 


25.50 


30.60 


25-50 


25.00 


31 .90 


35.00 


44.70 


31 .90 


38.30 


06 


40.00 


44.70 


56.00 


48.00 


40.00 


45.90 


50.00 


60.00 


44.70 


60.00 


07 


7.70 


7.70 


8.90 


8.90 


7.70 


10.00 


10.20 


12.80 


8.90 


10.00 


08 


20.00 


25.00 


15.00 


19. 10 


19.10 


18.00 


19.10 


25.00 


21 .00 


25.00 


09 


528.00 


490.00 


528.00 


528.00 


528.00 


535.90 


535:90 


535.90 


500.00 


574.20 


10 


540.00 


434.00 


540.00 


540 . 00 




7 1 4 . 60 


574.20 


6 1 2 . 50 


638.00 


6 1 2 . 50 


11 


15.30 


12.80 


15.00 


15.00 


17.00 


12.80 


12.80 


19. 10 


18.50 


19. 10 


12 


12.80 


16.00 


19. 10 


1 5 . 30 


12.80 


18.00 


12.00 


15.30 


15.00 


15.00 


13 












140.40 


127.60 


147.40 


1 14.80 


1 1 4 . 80 


14 


24.00 


25.00 


30.00 


25.50 


31 .90 


3 1 . 90 


30.00 


25.00 


38.30 


35.00 


15 












181 .50 


63.80 


220.00 


220.00 


220.00 


16 












765.60 


800.00 


829.40 


765.60 


765.60 


17 


10.00 


15.30 


10.00 


10.00 


10.00 


15.00 


9.60 


15.00 


10.00 


12.80 


18 


612.50 


612.50 


500.00 


612.50 


6 12. 50 


614.40 


560.00 


459.40 


612.50 


612.50 


19 


306.20 


255.20 


306.20 


280 .70 


306.20 


306.20 


285.00 


3 1 6 . 00 


320.00 


350.00 


20 


25.00 


25.00 


30.00 


25.00 


31 .90 


23.00 


30.00 


31 .90 


25.50 


31 -90 


21 


229.70 


191 .40 


240-00 


229.70 


248.80 


243.00 


229.70 


255.20 


250.10 


229.70 


22 


405.00 


446.60 


420.00 


459.40 


440-00 


459.40 


459.40 


490.00 


518. 10 


478.50 


23 


243.00 


268.00 


285.00 


287. 10 


268.00 


268.00 


268.00 


297.00 


315.00 


268.00 


24 












35.00 


48.00 


66.00 


61 .25 


60.00 


25 


15.00 


12.80 


12.80 


12.80 


15.00 


15.30 


10.00 


12.00 


15.30 


10.00 


26 


450.00 


450.00 


450.00 


450.00 


4 50.00 


612.50 


612.50 


660.00 


612.50 


612.50 


27 


612.50 


612.50 


632.00 


612.50 


6 12. 50 


606.10 


612.50 


660.00 


700.00 


612.50 


28 


535.90 


535.90 


460.00 


535.90 


5 1 . 40 


574.20 


525.00 


574.20 


630.00 


574.20 


29 












612.50 


560.00 


638.00 


561.40 


510.40 


30 


15.00 


15.00 


15.00 


15.00 


13.00 


6.40 


6.00 


6.00 


5.10 


6.40 


31 


30 . 00 


25.00 


28.00 


25.50 


22.50 


10.50 


9.00 


10.00 


9.50 


10.20 


32 


19.00 


30 . 00 


21 .00 


15.30 


23.80 


13. 2Q 


9.00 


10.00 


8.00 


8.00 


33 


30.00 


42.00 


45.90 


19.10 


38.30 


28.00 


20.00 


19.10 


17.50 


31 .90 


34 


35.00 


35 . 00 


38.30 


53.60 


35 . 00 


26.30 


18.00 


17.90 


15.00 


31 .90 


35 












10.00 


10.00 


10.00 


8.00 


7.00 


36 












14.40 


15.00 


9.00 


5.00 


15.00 


37 


3.00 


3.00 


4.00 


3.00 


2.50 


3.30 


3.00 


3.00 


2.50 


3.00 


38 


3.50 


3.00 


3.50 


3.00 


2.00 


3.20 


3.00 


3.00 


2.50 


3.00 


39 


14.00 


9.00 


9.00 


15.00 


9.00 


12.00 


9.00 


9.00 


8.00 


8 . 00 


40 


6.50 


6.00 


5.00 


6.50 


5.00 


8.00 


5.00 


7.50 


6.00 


6.00 


41 


3.00 


3.00 


3.00 


3.00 


2.50 


3.20 


3.00 


3.00 


2.50 


3.00 


42 


5.50 


5.00 


5.50 


5.00 


5.00 


5.50 


5.00 


5.50 


5.00 


5 . 50 


43 


4.00 


:::: 4.00 


3.00 


5.00 


4.00 


5.60 


4.00 


4.00 


3.50 


4.00 


44 


7.00 


6.00 


6.00 


6.00 


5.00 


8.00 


6.00 


6.80 


6.00 


6 . 00 


45 


8.00 


5.00 


5.00 


6.00 


5-00 


6.50 


5.00 


7.50 


6.00 


6.00 


46 


8.00 


7.00 


16.00 


12.00 


10. 00 


7.50 


6.80 


7.50 


6.00 


7.00 


47 


4.00 


3.50 


4.00 


4.00 


4.00 


5.00 


4.00 


4.50 


4.00 


5.00 


48 


20.00 


20.00 


20.00 


25.00 


21 .00 


24.00 


18.00 


22.50 


17.00 


19.50 


49 


45.00 


45.00 


45.00 


45.00 


45.00 


47.10 


47.10 


47.10 


42.00 


47.10 


50 



151 



WYOMING 




One Locality - Statewide 



152 



* 



1977 PREVAILING CHARGE SUMMARY DATA EQUITABLE LIFE ASSURANCE SOCIETY 

LOCALITY DESIGNATION FOR GENERAL PRACTICE 



PROCEDURE DESCRIPTION 



INITIAL LIM 
INITIAL COM 

03 MINIMAL OFF 

04 ROUTINE 8RI 

05 ROUTiNE BR I 
INITIAL BR I 
INITIAL COM 

08 ROUTINE BRI 

09 BIOPSY SKIN 
RADICAL MAS 
REDUCTION 

12 ARTHOTMY 

13 NEEDLE PUNC 

14 BRONCHOSCOP 

15 THORACENTES 

16 CATHETERTZA 

17 INSERTION 

18 BLOOD TRANF 

19 COLECTOMY 

20 APPENDECTOM 

21 SIGMOIDOSCO 

22 HEMORRHOIDS 

23 CHOLECYSTEC 

24 REPAIR HERN 

25 CYSTOSCOPY 

26 DILATION OF 

27 PROSTATECTO 

28 ELECTROSECT 

29 HYSTERECTOM 

30 EXTRACTION 
X-RAY CHEST 
X-RAY SPINE 
X-RAY HIP 

34 X-RAY STOMA 

35 X-RAY COLON 

36 COBALT 

37 RADIOTHERAP 

38 HEMOGLOBIN 

39 WHITE CELL 

40 COMPLETE BL 

41 CHOLESTERAL 

42 HEMATOCRIT 

43 PROTHROMBIN 

44 SEDIMENTATI 

45 BLOOD SUGAR 

46 BUN UREA NI 

47 PAP TEST 

48 URINALYSIS 

49 ELECTROCARD 

50 ELECTROENCE 



01 
02 



cs 

07 



10 

11 



31 
32 
33 



ITED OFFICE VISIT 
P OFFICE VISIT 
ICE VISIT 
EF OFFICE VISIT 
EF HOME VISIT 
EF HOSPITAL VISIT 
P HOSPITAL VISIT 
EF HOSPITAL VISIT 

TECTOMY 

F FRACTURE 

TURE OF BURSA 

Y 

IS 

TION 

F PACEMAKER 

USION 

Y 
PY 

CTOMY 

TOMY 

IA 

URETHRA 
MY 

ION OF PROSTATE 
Y 
OF LENS 



CH 



COUNT 
OOD COUNT 
BLOOD COUNT 



ON RATE 
TRATE 



IOGRAM 
PHALOGRAM 



3 
7 

12 



05530 

15.00 

25.00 

00 

70 

80 

20.00 

35.00 

9.60 

16.80 

446.70 

400.00 

10.30 

10.00 

108.00 

22.50 

146.00 

600.00 

10.00 

450.00 

255.30 

16.00 

210.00 

408.50 

250.00 

40.00 

15.00 

loOC. CO 

577.20 

577.20 

529.10 

12.00 

25.00 

18.00 

23.00 

26.50 

9.00 

10.00 

3.25 

3.25 

9-70 

8. 10 

3.25 

5.60 

4.80 

8.10 

8. 10 

8. 10 

4.00 

17.00 

60.20 



WYOMING 
LOCALITY DESIGNATION FOR SPECIALIST 
05530 






15. 

44. 

2. 

8. 

15. 

35. 

50. 

10. 

15. 

510. 

510. 

15. 

12. 

104. 

20. 

146. 

574. 

10. 

522. 

285. 

19. 

182. 

450. 

255. 

38. 

12. 

Fta.0. 

510. 

574. 

536. 

16. 

19. 

16. 

38. 

38. 

9. 

10. 

3. 

3. 

9. 

7. 

3. 

5. 

4. 

7. 

7. 

7. 

3. 

19. 

64. 



00 

70 

00 

90 

00 

00 

00 

00 

00 

60 

60 

00 

50 

70 

00 

00 

40 

00 

00 

00 

20 

00 

00 

30 

30 

00 

00-)* 

60 

40 

10 
60 
00 
50 
30 
30 
00 
00 
10 
10 
25 
70 
10 
40 
60 
70 
70 
70 
85 
20 
40* 



v :. ■■ 



01 
02 
03 
04 
05 
06 
07 
OS 
09 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 



153 



15U 



s 



APPENDIX A 



155 



Appendix A 



ALABAMA 

Six Localities: 

C\L Seven N.W. Counties: Colbert, Fraru_Lin, Lauderdale, 
Lawrence, Limestone, Madison, Morgan 

02 Six North Central Counties: Calhoun, Dekalb, Etovah, 
Fayette, Marshall, Tuscaloosa 

03 Eight S.E. Counties: Butler, Covington, Crenshaw, 
Dallas, Houston, Lee, Montgomery, Russell 

04. Two S.W. Counties: Baldwin, Mobile (city) 

05 One large Metropolitan County: Jefferson 

06 Forty-one small Rural Counties: 



Autauga 


Henry 


Barbour 


Jackson 


Bibb 


Lamar 


Blount 


Lowades 


Bullock 


Marengo 


Chambers 


Marion 


Cherokee 


Monroe 


Chilton 


Perry 


Clark 


Pickens 


Clay 


Pike 


Clebourne 


Randolph 


Coffee 


St. Clair 


Conecuh 


Shelby 


Coosa 


Sumter 


Cullman 


Talladega 


Dale 


Tallapoosa 


Elmore 


Walker 


Escambia 


Washington 


Geneva 


Wilcox 


Grocne 


Winston 


Halo 





156 



ARIZONA 



Six Local i ties: 

01— Phoenix-including Avondale, Chandler, Clearwater Hills, Cashion, Desert Sage, El Mirage, Gilbert, 
Glendale, Goodyear, Guadalupe, Litchfield Park, Mesa, Paradis Valley, Peoria, Scottsdale, 
Sun City, Surprise, Tempe, Tolleson, and Youngtown. 

02-Tucson— including Casas Adobes, Catalina Foothills, Desert Steppes, Indiana Ridge Estates, Sherwood 
Village, South Tucson, and Vista Del Sahuaro. 

05— Flagstaff 

07— Prescott 

08— Yuma 

99— All other parts of the State 



(City limits are exact boundaries of localities) 



157 



CALIFORNIA 



Appendix A 



Twenty-eight Localities - Conform to PSRO Areas: 

Hue- Shield handles all of 1-ii and the hedicare^iedi-Cal 
Claims from 15-28 

Occidental handles non-Hedi-Cal Claims from 15-28 

There are 42 screens for California as a result of the overlap. 

01 - Del Norte, Humboldt, Lake, Mer.docino, Sonoma 

02 - Butte, Colusa, Glenn, Lassen, Modoc, Plumas, Sierra, Shasta, 

Siskiyou, Sutter, Tehama, Trinity, Yuba 

03 - Harin, Napa, Solano 

Tft - El Jtarado, Nevada, Placer, Sacracento, Tolo 

05 - San Francisco 

6 - San Mateo 

0? - Alameda & Contra Costa 

08 — Alpine, Amador, Calaveras, San Joaquin 4 Tuolumne 

09 - Santa Clara 

10 - Mariposa, Merced, Stanislaus 

11 — Madera, Fresno 

12 - Monterey, San Benito, Santa Crua 

13 - Kings and Tulare 

14 - Kern 

15 - Inyo, Mono, San Bernardino 

16 - San Luis, Obispo, Santa Barbara 

17 - Ventura 



(Localities 18 through 2£ are composed of cities and 
parts of Los Angeles denoted by ZIP Codes) 



18 



19 



20 



21 



Al taden j 
Alhambra 
San Marino 
Tujunga 
Glendale 
San Gabriel 
Temple City 
Sunland 

Avalon 

Wilmington 

Palos Verdes Estates 

Long Beach 



Vcrdugo City 

Pasadena 

Garvey 

Eagle Rock 

Rosemead 

La Crescenta 

Montrose 



Terminal Island 
Hawaiian Gardens 
Lake wood 
San Pedro 



Agou ra 

Palmdale 

Chatsworth 

Burbank 

Hidden Hills 

Olive View 

Raseda 

San Fernando 

Tarzana 

Sun Valley 

Lancaster 

Commerce 

Glendora 

East Los Angeles 

Rowland Heights 

Norwalk 

Valinda 

KMttier 

La Verne 

Baldwin Park 

Hal nut 



Llttlerock 
Canoga Park 
Quartz Hill 
Granada Hills 
North Hollywood 
Northridge 
Panorama City 
Sherman Oaks 
Studio City 
Woodland Hills 
Toluca Lake 

Ourate 
La Mirada 
Monrovia 
Montebello 

Santa Fe Springs 
Claremont 
Azusa 
San Oimas 



La Vina 

El Monte 

South .Pasadena 

Monterey Park 

La Canada 

South San Gabriel 

Wilmar 



Dcmtniucz 

Harbor City 

?a!os Verdes Peninsula 

Los Alamitos 



Calabasas 

Pearblossoa 

Encino 

Mission Kills 

Newhall 

Pa co i ma 

Saugus 

Sepulveda 

Van Nuys 

Sylmar 



Hacienda Heights 
La Puente 
Los Nietos 
Sierra Madre 
Pico Rivera 
West Covina 
Arcadia 
Pomona 
Covina 



158 






Appendix A 



CALIFORNIA pg. 2 



22 



23 



2I> 



Culver City 




Santa Monica 


Malibu 


Saw telle 




Marina del Rey 


Venice 


Mar Vista 




Westwood 


Ocean Park 


Pacific Pa Hades 


Palms 


Playa del Rey 


Los Angeles 


Postal 


Zones: 




90034 




90049 


90064 


90066 




90073 




Gardena 




Rolling Hills 


Hermosa Beach 


Torrance 




Lomita 


Artesia 


Manhattan Beach 


Bell 


Palos Verdes 


Bell flower 




Rcdondo Beach 


Bell Gardens 


Compton 




Willowbrook 


Downey 


El Segundo 




Home Gardens 


Hawthorne 


Huntington 


>ark 


Inglewood 


Lynwood 


Lawndale 




Haywood 


Lennox 


Paramount 




South Gate 




Los Angeles 


Postal 


Zones : 




90009 




90045 




Los Angeles 


Postal 


Zones: Metropolitan 


Center 


90006 




90013 


90033 


90008 




90056 


90007 


90012 




90023 


90053 


90043 




90062 


90018 


90058 




90005 


90014 


90035 




90042 


90059 


90002 




90016 


90031 


90003 




90055 


90004 


90057 




90020 


90039 


90037 




90001 


90010 


90017 




90065 


90054 


90047 




90026 


90019 


90021 




90011 


90063 


90061 




9001 5 


90051 


90032 




90044 





25 ■* Beverly Hills 

Los Angeles Postal Zones: 
90027 90028 

90036 90038 

90048 90068 

26 t Orange County 



27 « Riverside County 



28 : San Diego 4 Imperial Counties. 



90029 
90046 
90069 



159 



Appendix A 



COUt!F.CTTCUT 

Four Localities: 

01- Northwest and North Central - City of N'-w London . Hartford County . 

IAtchfiold County (except New Milford, Washington, Bridgewater, 
and Roxbury Townships), Tolland County (except Willington, 
Coventry, Mansfield, and Columbia Townships), and Southbury, 
Middlebury, Waterbury, Wolcott, Naugatuck, Beacon Falls, 
Prospect, Cheshire, Wallingford, and Meriden Townships in 
New Haven County . 

02- Southwest - New Milford, Washington, Bridgewater, and Roxbury 

Townships in Litchfield County and Fairfield County (except 
Monroe, Shelton, Trumbull, Easton, Fairfield, Bridgeport, and 
Stratford) . 

03 - South Central - Oxford, Seymour, Darby, Orange, Ansonia, Bethany, 

Koodbridge, Hamden, North Kaven, New Haven, North Branford, 
Guilford, Madison, Branford, East Haven, West Haven, and 
Milford Townships in Hew Haven County and Monroe, Shelton, 
Trumbull, Easton, Fairfield, Bridgeport, and Stratford 
Townships in Fairfield County . 

04 - Northeast and Southeast - Middlesex County , New London County 

(except the City of Now London ). Windham County , and Willington, 
Coventry, Mansfield, and Columbia Townships in Tolland County . 



l6o 



Appendix A 



GEORGIA 



Pour Localities (by counties): 

01 Pulton, Clayton, Dekalb, Butts, Cherokee, Cobb, Douglas, 
Fayette, Forsyth, Gwinnett, Henry, Newton, Baulding, 
Rockdale, Walton 

02 Chatham, Houston, Bibb, Richmond, Muscogee 

03 Whitfield, Floy-J Troup, Coweta, Hall, Spalding, Clarke, 
Baldwin, Laurens, Bulloch, Ware, Glynn, Lowndes, Dougherty, 
Catoosa, Thomas, Walker 



04 Lumpkin 


Habersham 


Upson 


Talbot 


Union 


Stephens 


Chattahoochee 


Crawford 


Towns 


Franklin 


Polk 


Pike 


White 


Hart 


Haralson 


Heard 


Rabun 


Jackson 


Carroll 


Pikens 


Banks 


Madison 


Seminole 


Gilmer 


Oconee 


Elbert 


Miller 


Dade 


Oglethorne 


Barrow 


Baker 


Dawson 


Lincoln 


Dodge 


Atkinson 


Newton 


Taliaferro 


Randolph 


Lanier 


Morgan 


Jasper 


Terrell 


Clinch 


Greene 


Putnam 


Crisp 


Echols 


Wilkes 


Hancock 


Sumter 


Calhoun 


McDuffie 


Glascock 


Dooly 


Clay 


Columbia 


Warren 


Macon 


Quitman 


Washington 


Chattooga 


Peach 


Stewart 


Jefferson 


Gordon 


Harris 


Webster 


Burke 


Murray 


Merriwether 


Schley 


Emanuel 


Bartow 


Lamor 


Marion 


Screvin 


Fannin 


Monroe 


Taylor 


Ettingham 


Toltnall 


Liberty 


Long 


Toombs 


Appling 


Wayne 


Brooks 


Grady 


Decatur 


Colquitt 


Worth 


Ben Hill 


Early 


Cook 


Tift 


Tel Fair 


Mitchell 


Borrien 


Coffee 


Jones 


Wilkinson 


Jenkins 


Bleckley 


Montgomery 


Twiccs 


Truotlon 


Palaski 


Evans 


Johnson 


Candles 


Whcoler 


Bryan 


Jeff Davis 


Bacon 


Mcintosh 


Carudon 


Charlton 


Brantley 


Pierce 


Irwin 


Turner 


Loo 


Wilcox 





Ifl 



Appendix A 



ILLINOIS 

Sixteen Localities: 

Hue Cross/Blue Shield - Illinois Medical Service 
Cook County 

Continental Casualty - Illinois 

01- Jo Daviess, Stephenson, Carroll, Ogle Counties 

03- Winnebago, Mellenry 

03- Whiteside, Lee, DeKalb, Kendall, LaSalle, Bureau, Grundy, 
Putnam Counties 

<Xr- Rock Island, Henry, Stark, Knox, Mercer, Warren 4 Henderson 
Counties 

05- Peoria, Wood lord 4 Marshall Counties 

06- Kankakee, Iroquois, Ford 4 Livingston Counties 

07- Hancock, McDo jiough, Schuyler, Brown, Cass, Morgan, Greene, 
Pike, Adams 4 Scott Counties 

08- McLean, DeWitt t Logan, Tazewill, Mason 4 Fulton Counties 

09- Menard, Sangamon 4 Christian Counties 

10- Vermillion, Champaigne 4 Piatt Counties 

11- Edgar, Douglas, Moultrie, Macon, Shelby, Cumberland, Coles 
& Clark Counties 

13- Calhoun, Jersey, Macoupin, Montgomery, Bond, Madison, Clinton, 
Washington, St. Clair, Randolph 4 Monroe Counties 

13- Crawford, Jasper, Effingham, Fayette, Marion, Clay, 
Richland, Lawrence, Wabash, Wayne, White, Hamilton. 
Jefferson, Edwards Counties' 

Ur Gallatin, Saline, Franklin, Perry, Jackson, Williamson, 

Hardin, Pope, Johnson, Union, Alexander, Pulaski, Massac Counties 

15- Lake, Kane, DuPage 4 Will Counties 



162 



Appendix A 

Indiana 



Three Localities: 



01 -. Metropolitan- 

Lake, Porter, LaPorte (Northwest Indiana) 

Allen (Ft. Wayne) 

Marion (Indianapolis), Shelby 

Madison, Delaware (Anderson, Muncie) 

Vanderburgh (Svansville) 

02 - Urban- 

Monroe, Grant, Tippecanoe, St. «Joseph( South Bend), Clark, 
Wayne, Wells, Floyd, Vigo( Terre Kaute) , Elkhart, Howard, 
Cass* Henry, Lawrence, Kosciusko, Bartholomew, Hancock, 
Hendricks, Johnson, Knox, LaGrange , Daviess 

03 - Rural- Remaining Counties 



163 



MASSACHUSETTS 



Two Localities: 01 Urban, 02 Suburban/Rural 



Appendix A 



Boston SMSA (cont.) 



AREA 01 - Urbo/i - includes tho folio.'!.'./; places 










(Suffolk County) 


BOSTOK SMSA 






boston 


TflTsix County) 


Arlington 


Cdasset 




Beverly 






Chaises 




Ashland 


Oedha.ni 




Lynn 






Revere 




Bedford 


Dover 




Peabocly 






Wlnthrop 




Beliriont 


tolbrook 




Sal en 










Burlingtoi. 


Medffeld 


BROCKTON SI-ISA 


Danvers 






IBrfstbi County) 




Concord 


111111s 




Itallton 






Easton 




r'ranlngham 


Hilton 




Lynnficld 






(Norfolk County) 




Lexington 


lleedham 


Avon 


Manchester 










Lincoln 


Norfolk 


Stoughton 


Karblelieao.' 










Natkk 


Norwood 


(Plyr.outh County) 


Middloton 






Brockton 




Korth Readr.g 


Randolph 




Hahant 






Ablngtcn 




Reading 


Sharon 




Saugus 






Bridgewatcr 




Sherfcorn 


V.'alpole 




Swampscott 






East Bridgewatcr 




Stnncham 


Wellesley 




Topsf idd 






Hanson 




Sudbury 


Wcstwood 




Wen ham 






l.'est Bridgew?.ter 




Wakefield 


Weymouth 




(.".irfdlesex County) 






Whitman 


Cerebri d(ju 


WatcrU'Wn 


(Plymouth County) 
buxbury 




Everett 


Waylnnd 




l.TCCCSTER SHSA 






Hanover 


(Worcester County) 


Maiden 


Weston 


hlngha-n 


Worcester 


Hedford 


Wilr.iingto;i 


Hull 


Auburn 


Helrose 


Winchester 


Karshflcld 


Berlin 


Hew ton 


(Norfolk Ccuni ' 




Boylslon 




Qutncy 


liorwoll 




Somervtlle 






Brookflcld 




Bralntreo 


Pembroke 




Waltham 






East Brookflcld 




Breokllne 


Rockland 




Woburn 


Canton 


Scltuate 


Grafton 
llolden 



Leicester 

Mil) bury 

Northborcugh 

Horllibrldge 

Korth Brookflcld 

Oxford 

Pax ton 

Shrewsbury 

Spencer 

Sterling 

Sutton 

Upton 

Westborough 

SPRlHGHELD-CmCOPEE- 
" MLYHOKE. lUS573c?W. 

sfes 

Mass, portion 
(Hampden County) 

Chlcopee 

Hoi yoke 

Springfield 

Westflcld 

Agawam 

East Longmeadow 

Hampden 

Longmeadow 

Ludlow 

Honson 

Palmer 



SoutUIck 
West Springfield 
Wilbraham 
(Hampshire County) 
Northampton 
Easthanpton 
Granby 
Hadlcy 
South Hadlcy 
(Worcester County) 
Warren 

PITTSHElu SMSA 
(Berkshire County) 
Pittsficld 
Dal ton 

Lanesborough 
Lee 
Lenox 



16U 



Appendix A 



KASSAGHUSETTS (Cont'd) 

AEEA 02 - Suburban/Rural - includes the following places in 
SHSA's and the remainder of the State. 



FALL KIVrR, MASS. -ft. I. 


Westford 


(Norfolk County) 


SK>A_ 






Mass, portion 


New Bedford, Mass. 
SHSA 


Bellingham 


(Bristol County) 


(Bristol County) 


Franklin 


Fill River 


New Bedford 


Plalnvlllc 


Somerset 


Acushnet 


Wrentham 


Swansea 


Dartmouth 


(Worcester County) 


Westport 


Falrhavcn 


Blackstone 


LAURENCE -HAVERHILL .MASS. - 




H1l)v1l1e 


""OT~SH5A 


(Plymouth County) 




Mass, portion 


Marlon 




(Essex County) 


Mattapolsett 




Lawrence 


FITCIBURG-LECXIKSTLR SV3A 




Haverhill 


(Middlesex County) 




Andover 


Shirley 




Georgetown 


Townsend 




Grovelend 


(Worcester County) 




Htrrfcac 


Fitchburg 




Hethuen 


Leominster 




North Andover 


Lunenburg 




West Newbury 


Westminister 




LOWELL, MASS. SMSA 








PROVlDEflCE-PAWTt'O'ET- 




(Middlesex County) 


SHSA" 




Lowel 1 


Mass. portion 




Blllcrka 


(Bristol County) 




Chelmsford 


Attleboro 




Dracut 


North Attlcborouch 




Tcwkshury 


P.choboth 




Tyngsborouoh 


Seckonk 





165 



MISSISSIPPI Appendix A 



Two Localities: 

01- Rural - All ZIP Codes starting with 386,387,388,389,390,391,393, 

394,396,397 (except 38801, 39301, 39401) and the 

following 395 ZIP Codes: 
39550-Bond 39561-McHenry 

39552-Escatawpa 39572-Pearlington 
39553-Gautier 39573-Perkinston 
39555-Hurley 39574-Saucier 

39556-Kiln 39575-Wade 

39558-Laks shore 39577-Wiggins 



02- Metropolitan - All ZIP Codes starting with 392 and 395 (except as 
noted in area 01 above) . and the following: 

392 Jackson 

395__ Biloxi 
38801 Tupelo 
39301 Meridian 
39401 Hattiesburg 



ia 



Appendix 
MISSOURI 



Seven Localities: 



General American Life 

01 - Cities of Columbia, Jefferson City, Springfield, Metropolitan St. Louis, 

St. Louis County and St. Charles County 

02 - Cities of Joplin, Cape Girardeau, Kirksville, Poplar Bluff, Hannibal, 

Sikeston and Jefferson County (City limits boundaries except Jefferson County) 

03 - Rural - rest of State except Blue Shield of Kansas City area 

Blue Shield of Kansas City - Missouri 
I - Buchanan County (rural) 
II - Clay and Platte Counties (suburban) 
III - Jackson County (metropolitan) 

VI - Rural - Andres, Atchison, Bates, Benton, Caldwell, Carroll, Cass, Clinton, 
Daviess, DeKalb, Gentry, Grundy, Harrison, Henry, Holt, Johnson, Lafayette, 
Livingston, Mercer, Nodaway, Pettis, Ray, St. Clair, Saline, Vernon, Worth 



167 



NEW YORK 



Appendix A 



Ten Localities: 

New York B/S of Greater New York 

A} New York County 

B) Bronx, Kings, Richmond, and Westchester Counties 

E^ Nassau County 

H; Dutchess, Orange, Putnam, Rockland, Suffolk, 

Sullivan, and Ulster Counties 
N) Columbia, Delaware, and Greene Counties 

Group Health Insurance - New York 

Queens County 

Blue Shield of Western New York 

Alleghany, Cattaraugus, Erie, Genesee, Niagara, Orleans 
and Wyoming Counties 

Genessee Valley Medical Care Inc. - New York 

Livingston, Monroe, Ontario, Seneca, Wayne and Yates 
Counties 



Metropolitan Life Insurance Company - New York 

Geographic Area I - Includes the following cities: 



Albany 
Binghamton 
Endicott 
Glens Palls 
Johnson City 



Saratoga Springs 

Schenectady 

Syracuse 

Utica 

Troy 



Cooperstown 
Marcellus 
Payetteville 
New Hartford 
Ogdensburg 



(The city limits are the locality boundaries.) 

Geographic Area II - All towns and communities in the 
following counties other than the nine cities shown 
in Area I: 



Albany 


Pulton 


Rensselaer 


Broome 


Hamilton 


Saratoga 


Cayuga 


Herkimer 


Schenectady 


Chautauqua 


Jefferson 


Schoharie 


Chemung 


Lewis 


Schuyler 


Chenango 


Madison 


St. Lawrence 


Clinton 


Montgomery 


Steuben 


Cortland 


Oneida 


Tioga 


Essex 


Onondaga 


Tompkins 


Franklin 


Oswego 


Warren 




Otsego 


Washington 



168 




o 

Appendix A 



Philadelphia 

hi u ro 1> e f 5 . c\\ o w n a r-e id <? 
\ a ? 'c I* wo el i p i ' { $ 6 f 
tU # postal ZIP 

Char EC Class 1 
Clunrcc Clnr.s 5L 



Pennsylvania Blue Shield 



169 



Appendix 




!h Tfu*?:i-r?-.l / ' hSTC li^!>a3_L!| 



\tf-<- 






Y 

s 



'-*-> 






; \ ^ • if I I ^ ■ /i i s ; v — 



j \h 

15T 





jf\ . i 



v-^>\ 



PiUsburoV 

|\\uw\b<?rs s\\«vtr\ 

\as\ two dioi^rs 
•po;-U[ ZIP co4 

Charge Class 1 
UJJJ Charr.e Class JL 



«re t'ac? 



o-f 






e 



Pennsylvania Blue Shield 



170 



Texas 



Appendix A 



Thirty-two Localities: 
Counties -(Ci'-les) 

014 - Bell (Killeen-Ft.Hood) 

015 - Bexar (San Antonio) 
019 - Bovde (Texarkar.a) 
023 - Brazoria (Freeport) 
031 - Cameron (Brownsville) 
057 - Dallas (Dallas) 

061 - Denton (Denton) 
068 - Ector (Odessa) 
071 - EL Paso (El Paso) 
084 - Galveston (Galveston) 

091 - Grayson (Sherman) 

092 - Gregg (Longview) 
101 - Harris (Houston) 

108 - Hidalgo (Pharr-KcAllen) 
123 - Jefferson (Beaumont) 
152 - Lubbock (Lubbock) 
155 - McLennan (waco) 
165 - Midland (Midland) 
178 - Nueces (Corpus Christi) 
181 - Orange (Orange) 
183 - Potter (Amarillo) 



212 - Smith (Tyler) 
220 - Tarrant (Fort Worth) 
.221 - Taylor (Abilene) 

226 - Tom Green (San Angelo) 

227 - Travis (Austin) 

235 - Victoria (Victoria) 

240 - Webb (Laredo) 

243 - Wichita (Wichita Falls) 

750 - North Central, North East Texas 

770 - Central, South, Southeast Texas 

790 - Panhandle and West Texas 



(The localities are determined 
on a County basis. The cities 
listed are major cities in 
the locality.) 

(Area 260 is the Statewide locality 
for certain specialties.) 



750 - Morris, Montague, Cooke, Fannin, Lamar, Red River, 
Collin, Hunt, Delta, Titus, Camp, Cans, Trinity, 
Marion, Harrison, Panola, Rusk, Wood, Hopkin3, Rains, 
Kaufman, Van Zandt, Parker, Ellis, Johnson, Hood, Jack,. 
Rockwall, Coryello, Comanche, Wise, Somervell, Erath, 
Bill, Bosque, Hamilton, Freestone, Limestone, Anderson, 
Havarro, Leon, Upshur, Houston, Madison, Franklin, 
Cherokee , Falls , and Young Counties . 

770 - Shelby, Sabine, Angelina, Newton, Jasper, Tyler, Polk, 
Sacogdoches, San Augustine, Walker, San Jacinto, 
Bardin, Chambers, Grimes, Montgomery, Robertson, 
Br a 7, as, Burleson, Washington, Lee, Williamson, Mills, 
lampasas, Burnet, Henderson, Aransas, San Saba, Austin, 
Colorado, Wharton, Gillespie, Blanco, KendaU, Kerr, 
Real, Hays, Caldwell, Fayette, Matagarda, Calhoun, 
Refugio, Lavaca, Gonzales, San Patricio, Kleberg, Waller, 
Kenedy, Willacy, Jim Wells, Duval, Brooks, Zapata, 
Starr, Jim Hogg, La Salle, Dinaitt, McHullen, Live Oak, 
Bee, Karnes, Wilson, A.tascosca, Frio, Zavala, Uvalde, 
Medina, Comal, Fort Bend, De Witt, Goliad, Bandera, 
Guadalupe, Jackson, Liberty, Milam, Llano, 'Bastrop Counties. 

790- Dallam, Sherman, Eansford, Ochiltree, Hartley, Moore, 

Hutchinson, Hemphill, Carson, Gray, Wheeler, Deaf Smith, 
Randal, Armstrong, Donley, Parmer, Castro, Swisher, 
Briscoe, Hall, Childress, Shackelford, Baily, Lamb, Hale 
Floyd, Motley, Cottle, Foard, Wilbarger, Clay, Archer 
Baylor, Knox, Dickens, Crosby, Hockley, Cochran, Yoakum, 
Terry, Lynn, Garza, Kent, Stonewall, Haskell, Gaines, 
Dawson, Borden, Schurry, Fisher, Jones, King, Winkler, 
Ward, Upton, Throckmorton, Runnels, Collingsworth, Brewster, 
Hardeman, Irion, Lipscomb, Menard, Oldham, Stephens, 
Palo Pinto, Andrews, Martin, Howard, Mitchell, Nolan, 
Callahan, Eastland, Hudspeth, Culberson, Reeves, Lovir.s-, 
Glasscock, Sterling, Coke, Coleman, Brown, Crane, Roberts, 
Regan, Concho, HcCulloch, Sutton, Mason, Schleicher, 
Crockett, Fecos, Jeff Davis, Presidio, Terrell, Val Verde, 
Kimble, Edwards, Kinney, and Maverick Counties. 



171 



WISCONSIN 

Eleven Localities: 

Surgical Care - fllue Shield Wisconsin 
Milwaukee— A 



Appendix A 



fisconsin Physicians Service 



JLue Shield (Counties) 




B 


C 


Ashland 


Adams 


Barron 


Columbia 


Bayfield 


Green Lake 


Burnett 


Juneau 


Chippewa 


Marquette 


Clark 


Monroe 


Douglas 


Waushara 


Iron 




Polk 




Price 




Rusk 




Sawyer 




Taylor 




Washburn 




D 


E 


Crawford 


Buffalo 


Grant 


Dunn 


Iowa 


Eau Claire 


LaFayette 


LaCrosse 


Richland 


Pepin 


Sauk 


Pierce 


Vernon 


St. Croix 




Trempeleau 




Jackson 



F 
Langlade 
Lincoln 
Marathon 
Oneida 
Portage 
Vilas 
Wood 



H 

Kenosha 

Ozaukee 

Racine 

Washington 

Waukesha 



J 

Calumet 
Fond du Lac 
Manitowoc 
Sheboygan 
Winnebago 



G 
Brown 
Door 
Florence 
Forest 
Kewaunee 
Marinette 
Oconto 
Outagamie 
Shawano 
Waupaca 



I 

Dodg" 

Green 

Jefferson 

Rock 

Walworth 



Dane 



<r U.S. GOVERNMENT PRINTING OFFICE: 1977- 241059:500 



172 



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